{"id":22806,"date":"2017-11-14T20:59:56","date_gmt":"2017-11-15T01:59:56","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-rctom\/submission\/brexits-nuclear-isolationism-threatens-uk-medical-patients\/"},"modified":"2017-11-14T21:00:50","modified_gmt":"2017-11-15T02:00:50","slug":"brexits-nuclear-isolationism-threatens-uk-cancer-patients","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-rctom\/submission\/brexits-nuclear-isolationism-threatens-uk-cancer-patients\/","title":{"rendered":"Brexit\u2019s Nuclear Isolationism Threatens UK Cancer Patients"},"content":{"rendered":"

“[UK] Ministers however seem to have inserted their heads firmly into the sand, hoping tricky problems will just go away.<\/em>”
\n— Steve Bullock, former EU Negotiator for the UK<\/p>\n

On the drizzly morning of June 23, 2016, few British voters were contemplating the future of technetium-99m (99m<\/sup>TC), a radioisotope essential to many medical procedures. At the National Health Service (NHS), however, concerns about the stability of the supply chain of medical isotopes would arise following the outcome of the Brexit referendum.<\/p>\n

As chemical elements made from weapons-grade uranium, the production and distribution of medical isotopes are regulated by the European Atomic Energy Community (Euratom).[1]<\/a> As part of Brexit, the UK Government has stated that it will withdraw from Euratom, threatening the country\u2019s ability to import critical nuclear material unless new agreements are reached with exporting countries and international regulators.<\/p>\n

Radioisotopes are used for medical procedures such as coronary disease diagnosis and cancer treatment. The NHS carries out more than 700,000 such nuclear medicine procedures each year, yet the UK has no domestic capacity to produce radioisotopes.[2]<\/a> For the 10,000 patients across the UK whose cancers are currently treated with imported radioisotopes, then, a seamless series of events must occur for them receive proper medical care. [3]<\/a><\/p>\n

Challenges abound: the amount of useful radiation from 99m<\/sup>TC halves every six hours, making it impossible to hold in a hospital\u2019s inventory.[4]<\/a> Instead, physicians obtain 99m<\/sup>TC through the decay of molybdenum-99 (99<\/sup>Mo), an isotope whose half-life of 66 hours makes it more suitable for transport and storage.[5]<\/a> Daily or weekly shipments of this radioisotope, however, are still required to meet the medical needs of the NHS.<\/p>\n

The supply chain begins much earlier\u2014likely in Kazakhstan, Canada, or Australia, where three-quarters of the world\u2019s uranium is mined.[6]<\/a> \u00a0After being enriched in Russia or the U.S., the uranium is purified in a nuclear research reactor to isolate 99<\/sup>Mo. Today, this production occurs primarily in the Netherlands (40%), Belgium (20%), and Australia (15%).[7]<\/a> Until now, the Euratom Supplies Agency controlled the final transport of nuclear material on behalf of member countries, including the UK. Going forward, the UK Government must establish new agreements and mechanisms to replace the Euratom Treaty.<\/p>\n

NHS faces political reality<\/strong><\/p>\n

Given the many points of failure in the radioisotope supply chain, it is baffling that the UK Government itself has brought on an interruption at the last stage of delivery. This has generated a thorny situation for the NHS, a civil service agency which cannot openly oppose its government. As such, the NHS has relied on industry experts such as the Royal College of Radiologists to raise public alarm and prevent access to radioisotopes from \u201cslip[ping] down the negotiations list.\u201d[8]<\/a><\/p>\n

While the NHS has made no public statements with its response to Euratom withdrawal, the agency is likely advising the government on a new UK nuclear safeguard system and international agreements. This must occur before March 2019, when the UK is slated to withdraw officially from the EU. Stakeholders across academia and industry, however, have expressed skepticism that rewriting the myriad of nuclear regulations is possible within two years.[9]<\/a> To prevent shortfalls of radioisotopes, the NHS may be pursuing a short-term strategy of advocating for a \u201csoft\u201d Euratom exit that would allow the UK to hold an associate membership like Switzerland\u2019s.<\/p>\n

Addressing long-term instability<\/strong><\/p>\n

In parallel with replacing Euratom, the NHS should budget for the cost increase of procuring radioisotopes in the short-term. With 97 percent of Euratom\u2019s uranium purchases made through long-term contracts, the UK will likely face cost increases if it is forced to participate in the spot-market, even temporarily.[10]<\/a> In recent years, spot prices have been up to twice as high as multiannual contracts.[11]<\/a> These additional costs of renegotiations will cascade throughout every stage of the supply chain. Thyroid cancer treatment and bone scans carried out by the NHS, then, will become more expensive.<\/p>\n

After Brexit formally occurs in 2019, the UK should pursue stable access to radioisotope supply, if not through domestic production, then through an international consortium. For instance, the NHS should explore whether UK investment in the two long-term projects to replace reactors in Belgium and the Netherlands\u2014which are scheduled to be decommissioned by 2026\u2014might help guarantee the supply of radioisotopes.[12]<\/a><\/p>\n

Aligning civil service interests<\/strong><\/p>\n

Brexit and the associated Euratom withdrawal have surfaced the implications of isolationist policies that upend established supply chains in highly-regulated industries. Particularly delicate is the role of a public agency with split allegiances. How should the NHS respond to Brexit given the clear misalignment of interests in which its \u201cshareholders\u201d are the members of UK public while its \u201cBoard\u201d is the UK Government? The consequences of failure are high.<\/p>\n

 <\/p>\n

[Word Count: 784]<\/p>\n

——————————————-<\/p>\n

[1]<\/a> Andrew Ward and Alex Barker, \u201cEU Exit Spurs Call for Deal on Radiotherapy,\u201d Financial Times, February 23, 2017, https:\/\/www.ft.com\/content\/185175e4-f9cd-11e6-9516-2d969e0d3b65.<\/p>\n

[2]<\/a> UK Parliamentary Offices of Science and Technology, \u201cSupply of Medical Radioisotopes,\u201d July 2017.<\/p>\n

[3]<\/a> UK Parliamentary Offices of Science and Technology, \u201cSupply of Medical Radioisotopes,\u201d July 2017.<\/p>\n

[4]<\/a> \u201cRadioisotopes in Medicine | Nuclear Medicine – World Nuclear Association,\u201d accessed November 14, 2017, http:\/\/www.world-nuclear.org\/information-library\/non-power-nuclear-applications\/radioisotopes-research\/radioisotopes-in-medicine.aspx.<\/p>\n

[5]<\/a> \u201cRadioisotopes in Medicine | Nuclear Medicine – World Nuclear Association.\u201d<\/p>\n

[6]<\/a> European Commission, \u201cEURATOM Supply Agency Annual Report 2016,\u201d 2017, http:\/\/ec.europa.eu\/euratom\/ar\/ar2016.pdf.<\/p>\n

[7]<\/a> \u201cRadioisotopes in Medicine | Nuclear Medicine – World Nuclear Association.\u201d<\/p>\n

[8]<\/a> \u201cRCR Statement on the Potential Impact of Leaving the Euratom Treaty | The Royal College of Radiologists,\u201d accessed November 14, 2017, https:\/\/www.rcr.ac.uk\/posts\/rcr-statement-potential-impact-leaving-euratom-treaty.<\/p>\n

[9]<\/a> UK Parliamentary Offices of Science and Technology, \u201cSupply of Medical Radioisotopes.\u201d<\/p>\n

[10]<\/a> European Commission, \u201cEURATOM Supply Agency Annual Report 2016.\u201d<\/p>\n

[11]<\/a> European Commission,\u00a0\u201cEURATOM Supply Agency Annual Report 2016.\u201d<\/p>\n

[12]<\/a> UK Parliamentary Offices of Science and Technology, \u201cSupply of Medical Radioisotopes.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Withdrawing from the little-known Euratom Treaty jeopardizes the NHS's supply of medical radioisotopes — a quintessential case of "you don't know what you've got until it's gone." <\/p>\n","protected":false},"author":10307,"featured_media":22812,"comment_status":"open","ping_status":"closed","template":"","categories":[3230,640,41,3239,2360,134],"class_list":["post-22806","hck-submission","type-hck-submission","status-publish","has-post-thumbnail","hentry","category-brexit","category-government","category-healthcare","category-isolationism","category-nuclear","category-uk","hck-taxonomy-organization-uk-national-health-service","hck-taxonomy-industry-health","hck-taxonomy-country-united-kingdom"],"connected_submission_link":"https:\/\/d3.harvard.edu\/platform-rctom\/assignment\/rc-tom-challenge-2017\/","yoast_head":"\nBrexit\u2019s Nuclear Isolationism Threatens UK Cancer Patients - Technology and Operations Management<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/d3.harvard.edu\/platform-rctom\/submission\/brexits-nuclear-isolationism-threatens-uk-cancer-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Brexit\u2019s Nuclear Isolationism Threatens UK Cancer Patients - 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