International air transport has been the main bottleneck in getting radioisotopes and nuclear medicines where they are needed during the COVID-19 pandemic, but Nuclear Medicine Europe (NMEu) says there are signs the situation is improving.

An NTP Logistics driver hands over a shipment from NTP medical radioisotopes to the SAA Cargo desk in Johannnesburg (Image: NTP)

"Air transportation options, including via scheduled commercial flights, have been increasing although there are still many last-minute changes and difficulties in transporting radioisotopes to some regions," the organisation's Security of Supply Working Group Emergency Response Team (ERT) said yesterday. Logistical changes "create short-term difficulties" in supplying medical radioisotopes, but no specific shortages are presently foreseen.

"Further, NMEu has been advised that nuclear medicine procedures are expected to increase in the coming weeks in both Europe and the US, and it is anticipated that there will not be a problem in meeting an increase in demand," it said.

The ERT's update came after Dutch national carrier KLM, which has previously refused to carry Class 7 radioactive materials such as radioisotopes, announced it would resume the transport of medical isotopes from Europe to the USA from 27 April. According to the Society of Nuclear Medicine and Molecular Imaging, KLM had notified it that "based on humanitarian needs and medical urgency" and following a "thorough safety audit", the airline would transport radioisotopes for a limited period of time (initially five weeks), "until United Airlines or a stable alternative is up to speed".

Separately, South African radioisotope producer NTP Radioisotopes has outlined how it has worked with South African Airways (SAA), as the airline announced a series of repatriation flights around the world. The collaboration has so far seen 14 emergency shipments of medical radioisotopes leave South Africa on SAA flights, headed for Europe, North America and South America.

"NTP had a crisis management plan and team in place even before the South African government announced the national lockdown, which enabled us to rapidly roll out measures to limit staff exposure and increase safety protocols, while still allowing essential production, maintenance and safety personnel on site," NTP Group Managing Director Tina Eboka said.

However, a number of orders were cancelled or could not be completed owing to flight changes and cancellations as air space and borders were gradually locked down due to COVID-19. Over ZAR17 million (USD912,000) in orders were lost in March alone due to the sudden lack of air freight options from South Africa, she said.

An International Atomic Energy Agency (IAEA) survey of major producers of radioisotopes previously found that, although production of medical radioisotopes had continued during the pandemic, bottlenecks in transport and distribution could lead to shortages at hospitals. In a 23 April webinar on the supply of medical radioisotopes and radiopharmaceuticals, hosted by the  IAEA, panellists from 18 countries observed that fewer radiological procedures are being carried out globally as healthcare professional focus on the COVID-19 response.

Most radioisotopes and radiopharmaceuticals are transported internationally via scheduled commercial flights. Such flights have been curtailed in response to the pandemic, which is particularly problematic for short-lived medical radioisotopes.

Mouldi Saidi, head of radiopharmacy at Tunisia's National Centre for Nuclear Sciences and Technologies (CNSTN), told the IAEA webinar that, prior to COVID-19, it had typically taken two days for shipments of Mo-99/Tc-99m generators from production sites in Germany and the Netherlands to Tunisia by scheduled flights via Dubai. A generator would be expected to have an activity of 840 mCi after such a journey. Now, he said, such a shipment would involve road transport from the production site to Maastricht, followed by cargo transfer via Istanbul - a more costly journey, taking 15 days and after which the activity of a generator would be around 500 mCi.

Stephen Whittingham, head of the IAEA's Transport Safety Unit, said many airlines are now starting to use "passenger" aircraft for cargo-only flights, but needed permission from air regulators to make such a change. Also, some carriers and airports have - like KLM - refused to carry Class 7 substances in the past. He called on producers and users of medical radioisotopes to consider steps including collaboration with airlines to strengthen their existing carrier network as necessary, and to consider engaging with potential new carriers.

Researched and written by World Nuclear News