Johannesburg – South Africa is one of the world’s largest producers of medical isotopes and a key player in the global nuclear medicine industry.
The country’s state-owned enterprise, NTP Radioisotopes, currently supplies approximately one-third of the global demand for molybdenum-99, a crucial isotope used in diagnostic imaging.
At the heart of this production is the SAFARI-1 research reactor, which has been in operation since 1965.
However, with its planned decommissioning by 2030, the question of replacement has become increasingly urgent.
Without a new multipurpose research reactor, South Africa risks losing its leadership position in nuclear medicine and facing disruptions in isotope supply both domestically and internationally.
The importance of isotope production cannot be overstated – globally, an estimated 80% of all radiodiagnostic procedures depend on molybdenum-99 and its decay product, technetium-99m.
Without a steady supply, millions of medical scans worldwide would be at risk, highlighting South Africa’s critical role in the global healthcare ecosystem.
Despite its strong position in isotope production, access to nuclear medicine services within South Africa remains uneven.
Most diagnostic and treatment facilities are concentrated in major urban centres such as Cape Town, Johannesburg, and Pretoria.
At present, 40 nuclear medicine departments operate within public and private hospitals, yet rural populations struggle with limited availability of diagnostic procedures and prolonged travel times to access care.
Expanding nuclear medicine facilities beyond metropolitan areas is critical to ensuring equitable healthcare access and improving early disease detection across the country.
South Africa is also grappling with one of the highest cancer burdens in sub-Saharan Africa, with cases rising due to population ageing and lifestyle changes.
The demand for targeted radiopharmaceuticals such as lutetium-177 and actinium-225 is growing, as these isotopes enable precise cancer treatments with minimal damage to surrounding healthy tissues.
Similarly, iodine-131 remains the most widely used isotope for treating thyroid disorders.
Additionally, theranostics – a revolutionary approach combining diagnostic imaging with targeted therapy – is gaining traction as a game-changing technique that could reshape cancer treatment in South Africa.
Lutetium-177 and actinium-225 are particularly promising for precision oncology, with applications in neuroendocrine tumours and prostate cancer.
Rosatom’s unique position as a supplier is underpinned by one of the most powerful scientific and technological bases in the world and a broad network of production sites capable of manufacturing nearly any isotope at an industrial scale.
The company was among the first in the world to begin producing Lu-177 and Ac-225, and remains the only supplier with a full production cycle – from raw materials to radiochemical products – for both isotopes.
This end-to-end capability ensures technological independence and consistent availability for cutting-edge cancer therapies.
South Africa’s membership in BRICS presents new opportunities for collaboration in nuclear medicine research and development.
For instance, Rosatom has established isotope supply partnerships with BRICS nations such as Brazil, India, and China.
These successful collaborations demonstrate the company’s ability to integrate into new markets and support emerging players in nuclear medicine.
For South Africa, it could bring significant advantages. Rosatom ranks among the world’s top five isotope producers, with its isotopes being delivered to more than 170 companies across 50 countries.
In addition to global partnerships, Rosatom’s production infrastructure is another major strength.
The corporation operates 14 facilities using reactor-based, cyclotron, generator, electromagnetic, gas centrifuge, and other methods to produce more than 300 types of isotopes.
The total catalogue of supplied isotope products exceeds 400 varieties, covering a wide range of diagnostic and therapeutic needs.
Its portfolio includes innovative solutions for precision medicine and cancer treatment, such as Lu-177 and Ac-225, and guarantees a steady and reliable supply.
The breadth of the company’s competencies and the presence of a unique pool of research and power reactors enable uninterrupted delivery of critical isotopes.
The company’s expertise extends beyond isotope production to include the development of medical infrastructure, the construction of radiopharmaceutical facilities, and the training of healthcare professionals.
By leveraging this expertise, South Africa could accelerate the establishment of a robust nuclear medicine ecosystem.
Continued government investment in nuclear medicine infrastructure will be essential in maintaining South Africa’s leadership in the field.
The replacement of SAFARI-1 with a modern multipurpose research reactor is vital to securing uninterrupted isotope production for both domestic and global markets.
Additionally, expanding education and training programmes is crucial, as the country currently has only 65 nuclear medicine physicians and 185 medical physicists – figures insufficient to meet the growing demand for nuclear medicine services.
By strengthening its nuclear medicine infrastructure, investing in theranostics, and forging international partnerships, South Africa has the potential to become a regional hub for nuclear medicine in Africa.
This strategic positioning would not only enhance healthcare outcomes within the country but also create new opportunities for medical tourism and radiopharmaceutical exports across the continent.
With the right investments and collaborations, South Africa can secure its place at the forefront of nuclear medicine innovation and ensure better healthcare for future generations.
