# A coordinated reserve and shared schedule for the world's medical isotope reactors

Source: https://onco.cc/ideas/idea-reg-medical-isotope-reactor-reserve/  
OnCo record `idea-reg-medical-isotope-reactor-reserve` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A handful of ageing research reactors make most cancer isotopes. Coordinating their maintenance and funding reserve capacity would prevent the shortages that stop treatments.

## Summary

Lutetium-177, iodine-131 and molybdenum-99 depend on a few research reactors (HFR Petten, BR2, MARIA, SAFARI-1, OPAL, several in Russia and the US), most over 50 years old. The OECD Nuclear Energy Agency's High-Level Group on Medical Radioisotopes coordinated molybdenum-99 after the 2009-10 crisis. The proposal is to extend that model formally to therapeutic isotopes: shared outage scheduling, an agreed reserve capacity margin funded by a per-dose levy, and public co-financing of the next generation of producers (PALLAS in the Netherlands, accelerator-based SHINE, new irradiation positions in existing reactors).

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Coordinated scheduling and reserve capacity reduce clinic-reported therapeutic isotope shortage weeks by at least 80% and keep lutetium-177 spot prices stable during planned reactor outages.
- Rationale: The molybdenum-99 experience showed that coordination, not new physics, ended a supply crisis; therapeutic isotopes now face the same concentration of supply with faster-growing demand.
- Proposed test: Publish a shared outage calendar and reserve-margin target for lutetium-177 producers within a year; track clinic-reported dose cancellations and prices against the prior three years.
- Maturity: early-clinical
- Actor: policy

## Sources

- OECD NEA medical radioisotopes: https://www.oecd-nea.org/jcms/pl_26262/medical-radioisotopes

## Connected records

- technologies: [Radioligand therapy (beta emitters)](https://onco.cc/technologies/radioligand-therapy/)
- bottlenecks: [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/)

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