Getty Images / Jack Taylor / Stringer

At the end of 2018, secretary of state for health Matt Hancock boasted that he was now the “world’s largest buyer of fridges” to stockpile food and drugs in case of a no-deal Brexit.

Since August 2018, when the UK government told pharmaceutical companies to stockpile medicines in order to navigate a no-deal scenario Brexit, doctors, drugmakers and NHS administrators have expressed doubts on the plan’s viability, given that Britain does not have enough cold chain warehouses to store the extra drug reserves.


But little attention has been given to another stark challenge that patients and clinicians might face. Some key diagnostic tools and cancer treatments rely on radioactive isotopes that would decay until they became effectively useless if they are held up in the anticipated six-week border delay that's expected from a no-deal Brexit.

There are roughly one million diagnostic nuclear medicine tests performed in the UK every year, according to the British Nuclear Medicine Society. The tests are less invasive than other diagnostic procedures, and are useful in the early detection of serious conditions, including dementia, stroke, ischaemia, Parkinson’s disease, pulmonary embolism, cancer, kidney diseases, and some kinds of epilepsy.

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These tests require administering a small amount of radioactive chemical tracer – typically injected into the bloodstream, inhaled or swallowed – which travels through the area being examined and gives off gamma rays that can be picked up by a scanner.

About 150,000 of these tests use a radiopharmaceutical called F-18 fluorodeoxyglucose (FDG), which only has a two-hour half-life, and is therefore made within 60 miles of the hospital where it is used. The remaining 850,000 tests use technetium-99m, a radioisotope with a 6-hour half-life used in bone, cardiac, lung, and kidney scans, and surgical procedures for breast cancer. Technetium-99 is produced by the radioactive decay of molybdenum-99 – a waste product from certain nuclear reactors.


Because they decay rapidly – the amount of useful radiation emitted by Tc-99m halves every six hours, and the yield of Tc-99m from Mo-99 halves every 66 hours – neither isotope can be stockpiled for long. Since the UK has no reactors capable of producing Mo-99, British hospitals have so far relied on weekly supplies by lorry from reactors in France, Belgium and the Netherlands.

The UK also imports Radium-223 from Norway to treat bone tumours, Iodine-123 from Belgium to treat thyroid cancer, and both Iridium-192 to treat cervical and prostate cancer, and Lutetium-177, to treat neuroendocrine tumours, from the Netherlands.

What if lorries are held up by post-Brexit paperwork? “That means a patient is getting half of the treatment you prescribe which – in the case of cervical cancer – means the treatment takes much longer,” says Jeanette Dickson, vice-president for Clinical Oncology at the Royal College of Radiologists.

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Every year, roughly 1,500 women and 2,000 men are treated with thin tubes inserted into the cervix or prostate gland and Iridium is passed down the tubes for a few minutes to destroy cancer cells before being removed. The treatment is often repeated several times a few days apart, on an outpatient basis. “At the moment treatments last 30 to 40 minutes,” says Dickson. “You can go through one half-life OK, but half way through the next one you lose efficacy.”

Lorries carrying radioactive isotopes may not even be allowed to park up and wait near Calais, due to the strict anti-terror regulations governing the storage of radioactive material. At the moment, the use and transport of radioactive material is governed by the rules of Euratom – an organisation that, although formally distinct from the EU, is subject to some of its institutions, including the European Commission and the European Court of Justice – but in 2017 the UK announced its intention to leave Euratom post-Brexit.

“Leaving Euratom risks breaking a series of time-sensitive supply chains,” says John Buscombe, president of the British Nuclear Medicine Society. “If we don’t have the isotopes, the tests can’t get done, because delivery is timed for the morning of an appointment. Patients may arrive at the hospital, find we have nothing to give them, and then go home and wait for another slot. A lymphoma PET scan is timed to be just before the treatment. If you delay the scan, you affect treatment outcomes, and patients may die.”

It is possible to fly isotopes over – currently, isotopes bound for Northern Ireland are flown in to Coventry airport, and indeed Hancock said there were plans in place for this.

“We have arrangements in place to bring [medical isotopes] in by plane,” Mr Hancock told the BBC.

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Even under the existing Euratom regime, however, Northern Ireland faced shortages of necessary isotopes in 2009 and 2013, due to supply chain issues. John Woods, the council chair of British Medical (BMA) Northern Ireland, warns that a hard border in Northern Ireland would disrupt and delay the region’s current fall-back option – importing supplies from Dublin.

"We recognise the vital importance of medical radioisotopes and action is being taken to safeguard supplies in the event of a no deal. Where medicines have a short shelf life and cannot be stockpiled, we have asked suppliers to have plans in place to air freight these medicines so patients can continue their treatment uninterrupted," the Department of Health and Social Care said in an emailed statement. "We continue to work closely with industry and the supply chain to ensure the continued flow of all medicines and medical products after we leave the EU."

“The problem is, our supply chains are built around lorries from the Channel,”Dickson says. “It would take a substantial, expensive and time-consuming process to reorganise all those supply chains, but we can’t consider the process until we have a clear picture on the post-Brexit deal.”

Until the terms of the Brexit deal are finalised, the NHS, clinicians, and the British Nuclear Medicine Society are struggling to plan for the worst, and have been asking the government for information and solutions. The outcome is still unclear.

Buscombe says: “The civil servants we’ve spoken to take it seriously, but they don’t know what to do."

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Updated 05.01.2019, 11.35 GMT: This article has been updated to include a statement from the Department of Health and Social Care

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