{"entity":{"id":"b-mo99-supply","kind":"bottleneck","name":"Molybdenum-99 supply","aka":[],"tldr":"Most of the world's everyday nuclear medicine scans depend on a radioactive metal, molybdenum-99, made in a handful of ageing research reactors. When one of them breaks down, hospitals thousands of miles away run short of scans within days because the material decays so fast it cannot be stockpiled.","summary":"Technetium-99m, used in roughly two-thirds of all nuclear medicine procedures worldwide, is generated on-site from its parent, molybdenum-99 (Mo-99, half-life 66 hours). Around 95% of global Mo-99 supply comes from a small set of research reactors, several of them from the 1950s-60s: BR2 (Belgium, commissioned 1961), SAFARI-1 (South Africa, 1965), LVR-15 (Czechia, 1957), MARIA (Poland, 1974), HFR (Netherlands, 1961) and OPAL (Australia, 2006, the newest of the group). These reactors were not built for continuous isotope production, so unplanned outages are common; the HFR was shut down in October 2024 for an unscheduled structural repair, compounding scheduled maintenance elsewhere and tightening Tc-99m availability in Europe and North America.\n\nBecause Mo-99 and its daughter Tc-99m decay too quickly to stockpile, the whole chain -- irradiation, chemical processing, generator manufacture, air freight, and hospital elution -- has to run on a near-continuous, just-in-time schedule with almost no buffer. The United States, which consumes more than half of global Tc-99m demand, has historically produced none of the Mo-99 it uses, importing all of it from these ageing overseas reactors.\n\nThe response has been diversification rather than a single fix: new LEU-target and cyclotron-based domestic production efforts in the US and Canada, a CMS reimbursement add-on to reward non-highly-enriched-uranium production, and a slow build-out of newer reactors and accelerator routes to replace the 1960s fleet as it eventually retires.","asOf":"2026-09-22","links":[{"label":"OECD-NEA: Current trends in the supply and utilisation of medical radioisotopes (Oct 2025)","url":"https://www.oecd-nea.org/upload/docs/application/pdf/2025-10/7743_medical_radioisotopes_supply_rev.pdf"},{"label":"McGuireWoods: Radiopharmaceutical industry update, CY2025 HOPPS rule and Mo-99 add-on payment","url":"https://www.mcguirewoods.com/client-resources/alerts/2025/4/radiopharmaceutical-industry-update-q4-q1-2024-2025/"},{"label":"INMM PATRAM 2010: Transport of radiopharmaceuticals, cradle to the patient","url":"https://resources.inmm.org/system/files/patram_proceedings/2010/233_Paper_TRANSPORT-OF-RADIOPHARMACEUTICALS,-CRADLE-TO-THE-P.pdf"}],"tags":["supply chain","molybdenum-99","technetium-99m","reactor infrastructure"],"related":["idea-reg-medical-isotope-reactor-reserve","idea-reg-isotope-supply-observatory","b-cold-chain-logistics","tc-99m","mo-99"],"indications":[],"sections":[],"technologies":["research-reactor-isotope-production","therapy-isotope-supply-chain","radionuclide-generators-kits"],"targets":[],"drugs":[],"companies":["northstar-medical-radioisotopes","shine-technologies","curium","ntp-radioisotopes","ire","ansto","nordion"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"stage":"regulation-manufacturing","severity":"major","metrics":[{"label":"Share of global Mo-99 supply from six ageing research reactors","value":"~95%","url":"https://www.oecd-nea.org/upload/docs/application/pdf/2025-10/7743_medical_radioisotopes_supply_rev.pdf"},{"label":"Oldest Mo-99-producing reactor still in service (LVR-15, Czechia)","value":"commissioned 1957","url":"https://www.oecd-nea.org/upload/docs/application/pdf/2025-10/7743_medical_radioisotopes_supply_rev.pdf"},{"label":"HFR (Netherlands) unplanned shutdown","value":"October 2024, structural repair","url":"https://www.oecd-nea.org/upload/docs/application/pdf/2025-10/7743_medical_radioisotopes_supply_rev.pdf"},{"label":"CMS add-on payment for Tc-99m from domestically produced (non-HEU) Mo-99","value":"$10 per dose, effective 1 January 2026","url":"https://www.mcguirewoods.com/client-resources/alerts/2025/4/radiopharmaceutical-industry-update-q4-q1-2024-2025/"},{"label":"Activity lost to a one-day transport delay of Mo-99 (66-hour half-life)","value":"~22%","url":"https://resources.inmm.org/system/files/patram_proceedings/2010/233_Paper_TRANSPORT-OF-RADIOPHARMACEUTICALS,-CRADLE-TO-THE-P.pdf"}],"causes":["Global Mo-99 production is concentrated in a small number of research reactors originally built for other purposes and now decades past their design life.","The isotope's 66-hour half-life means there is no meaningful stockpile; any outage propagates into a shortage within days.","Historic reliance on highly enriched uranium (HEU) targets created conversion costs and regulatory complexity when moving to low-enriched uranium (LEU).","Low economic return on Mo-99 production relative to its public-health importance has discouraged reactor operators from investing in dedicated new capacity."],"currentEfforts":["NorthStar Medical Radioisotopes and SHINE Technologies scaling non-uranium (accelerator- and fusion-based) domestic US Mo-99 production.","Canada's Darlington Nuclear Generating Station (CANDU) beginning Mo-99, Lu-177 and Y-90 production runs from 2025.","CMS's CY2025/2026 rule adding a $10-per-dose payment for Tc-99m derived from domestically produced, non-HEU Mo-99.","Private US test reactors (e.g. Oklo's Groves Isotope Test Reactor, first criticality August 2026) aiming to prove domestic medical-isotope production pathways."],"successLooksLike":"Mo-99 production diversified across enough LEU and non-reactor routes, in enough countries, that a single reactor's unplanned outage no longer causes a multi-country Tc-99m shortage."},"route":"/bottlenecks/b-mo99-supply/","neighbours":{"idea":[{"id":"idea-reg-medical-isotope-reactor-reserve","kind":"idea","name":"A coordinated reserve and shared schedule for the world's medical isotope reactors","route":"/ideas/idea-reg-medical-isotope-reactor-reserve/"},{"id":"idea-reg-isotope-supply-observatory","kind":"idea","name":"A global medical isotope supply observatory with forecasts and shortage alerts","route":"/ideas/idea-reg-isotope-supply-observatory/"}],"bottleneck":[{"id":"b-cold-chain-logistics","kind":"bottleneck","name":"Cold chain and time-critical logistics","route":"/bottlenecks/b-cold-chain-logistics/"},{"id":"b-enriched-target-material","kind":"bottleneck","name":"Enriched target material for therapeutic isotopes","route":"/bottlenecks/b-enriched-target-material/"},{"id":"b-reimbursement-coding","kind":"bottleneck","name":"Reimbursement and coding for radiopharmaceuticals","route":"/bottlenecks/b-reimbursement-coding/"}],"isotope":[{"id":"mo-99","kind":"isotope","name":"Molybdenum-99","route":"/isotopes/mo-99/"},{"id":"tc-99m","kind":"isotope","name":"Technetium-99m","route":"/isotopes/tc-99m/"}],"technology":[{"id":"radionuclide-generators-kits","kind":"technology","name":"Radionuclide generators and cold kits","route":"/technologies/radionuclide-generators-kits/"},{"id":"research-reactor-isotope-production","kind":"technology","name":"Research reactors for medical isotopes (Mo-99, Lu-177, I-131)","route":"/technologies/research-reactor-isotope-production/"},{"id":"therapy-isotope-supply-chain","kind":"technology","name":"Therapeutic isotope supply chain (Mo-99, Lu-177, Ac-225)","route":"/technologies/therapy-isotope-supply-chain/"}],"company":[{"id":"ansto","kind":"company","name":"ANSTO (Australian Nuclear Science and Technology Organisation)","route":"/companies/ansto/"},{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},{"id":"ire","kind":"company","name":"IRE (Institut national des Radioéléments)","route":"/companies/ire/"},{"id":"nordion","kind":"company","name":"Nordion (Sotera Health)","route":"/companies/nordion/"},{"id":"northstar-medical-radioisotopes","kind":"company","name":"NorthStar Medical Radioisotopes","route":"/companies/northstar-medical-radioisotopes/"},{"id":"ntp-radioisotopes","kind":"company","name":"NTP Radioisotopes","route":"/companies/ntp-radioisotopes/"},{"id":"shine-technologies","kind":"company","name":"SHINE Technologies","route":"/companies/shine-technologies/"}]}}