The European Medicines Agency (EMA) and the Heads of Medicines Agencies (HMA) have issued strategic recommendations to address critical vulnerabilities in Europe's radiopharmaceutical supply chain, responding to growing demand for these specialized cancer diagnostic and treatment medicines amid limited regional manufacturing capacity.
The recommendations, published on April 14, 2025, through the Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG), target a market projected to reach $11.06 billion by 2034, up from $6.97 billion in 2024. Radiopharmaceuticals, which contain radioactive isotopes and are used primarily in nuclear medicine for diagnosing and treating conditions such as cancer, face increasing demand while European manufacturing capacity remains constrained.
Complex Supply Chain Dependencies
The production of radiopharmaceuticals relies heavily on stable isotopes and materials sourced mainly from China, Russia, and other geopolitically sensitive regions. High-assay-low-enriched uranium (HALEU), used as fuel for research reactors, is currently not produced in the EU and can only be imported from Russia or the United States.
The supply chain complexity is compounded by the unique nature of most diagnostic radiopharmaceuticals, which are produced at the time of use because they begin to decay immediately upon creation. This prevents manufacturers from stockpiling radioisotopes, meaning small fluctuations in global supply can significantly impact manufacturing capabilities.
Major pharmaceutical companies including Bayer AG, Bracco Imaging, Cardinal Health, Curium Pharma, Eli Lilly, Lantheus Holdings, Novartis AG, and Nordion supply radiopharmaceuticals to healthcare facilities, forming partnerships with contract development and manufacturing organizations to expand reach and ensure reliable supply chains.
Strategic Recommendations for Supply Security
The MSSG recommendations focus on several key areas to mitigate supply chain vulnerabilities:
Domestic Production Enhancement: The recommendations emphasize increasing the European Union's domestic capabilities through initiatives including the European Observatory on the Supply of Medical Radioisotopes, co-chaired by the Euratom Supply Agency and Nuclear Medicine Europe, and the Strategic Agenda for Medical Applications of Ionising Radiation (SAMIRA).
Infrastructure Modernization: Priorities include improving aging infrastructure and enhancing production facilities such as nuclear reactors, alongside developing EU-based HALEU enrichment and metallization facilities.
Transport Harmonization: Addressing transport challenges through harmonization of certification procedures and standards across different countries, with extended monitoring to additional radioisotopes to ensure preparedness for rising demand.
Supply Diversification: Diversifying sources of key materials to reduce geopolitical risks and investing in modernizing and expanding EU-based production facilities.
Regulatory and Coordination Framework
Member States are advised to map their supply chains, coordinate transport solutions, and include new radiopharmaceuticals in horizon scanning activities. The recommendations encourage EMA to offer regulatory support, assist Member States with horizon scanning, and coordinate related activities to ensure efficiency and avoid duplication of efforts.
As of 2024, all radiopharmaceutical products are considered medicines in the EU, with industrially prepared products requiring authorization as pharmaceuticals. However, country-level regulation remains diverse, leading to significant differences in use and availability across the EU.
Ongoing Initiatives and Future Outlook
The European Radioisotope Valley Initiative (ERVI) is reviewing the EU's production capacity for metallic HALEU while examining ways to enhance enriched stable isotope production, strengthen medical radionuclide production, and develop more reliable supply and demand monitoring.
The Euratom Supply Agency, responsible for securing source materials for radioisotopes production, monitors the production chain of medical radioisotopes through the European Observatory on the Supply of Medical Radioisotopes as part of SAMIRA's comprehensive action plan.
The European Association of Nuclear Medicine welcomed the EMA's recommendations, stating they were "pleased to see such a political commitment to the supply of medical radioisotopes at the highest level. As the demand for radiopharmaceuticals grows, ensuring their consistent availability is paramount for patient care across Europe."
Efforts are underway to expand stable isotope enrichment capabilities outside of Russia to reduce dependency and enhance long-term security. New technologies may provide alternative approaches to reactor-based production, while construction of new research reactors, such as the PALLAS reactor in the Netherlands, will expand capacity for medical isotope production. However, legislative changes, including implementation of the Critical Medicines Act, are considered essential to minimize medicine shortage risks and safeguard EU citizen health.
