The Netherlands is about to become a leading nation in nuclear medicine, according to the ambitious DECISIVE initiative. This project, named “Dutch Isotopes Save Lives,” aims to strengthen the entire value chain of nuclear medicine. From the production of stable isotopes to the clinical implementation of new therapies, DECISIVE focuses on every link in the chain. We aspire to become a guiding country in nuclear medicine, not just in Europe but worldwide. The potential is there, the necessary knowledge is within reach, but collaboration is essential to create a robust nuclear ecosystem where the entire nuclear medicine chain can operate seamlessly.

This year, a grant application was to be submitted to the National Growth Fund (NGF), which is investing €20 billion between 2021 and 2025 in projects that contribute to the sustainable economy of the Netherlands. However, the NGF has recently been halted, making funding for DECISIVE uncertain. This underscores the need for alternative funding sources and strong cooperation between the government, industry, and academic institutions to realize the ambitions of strengthening the nuclear ecosystem.

Exponential Growth and Challenges
We have seen a long-term annual growth of 10% in diagnostic nuclear procedures, such as tumor detection, and we expect a fivefold increase in therapeutic applications by 2040. There are already regular shortages of medical isotopes, which will become problematic as demand increases. The Ministry of Health, Welfare, and Sport (VWS) recognized this issue earlier and launched a program directorate for medical isotopes in 2019 to ensure supply security. This led to a €1.8 billion investment in the development of the new Pallas reactor, which will replace the current Petten reactor. The current reactor already accounts for 30% of global medical isotope production. The new Pallas reactor will need to meet the growing demand in the coming years.

A Future-Oriented Vision
DECISIVE aims to transform the Netherlands into a world leader in nuclear medical diagnostics and treatment, fostering a healthier and more prosperous future. The Netherlands has the perfect foundation of infrastructure and expertise to achieve this vision. With the construction of the PALLAS nuclear reactor and the establishment of the American company SHINE and cyclotrons, the Netherlands is becoming a significant player in the global production of radioisotopes. However, producing radioisotopes is just the first step toward a diagnostic tool or drug.

From Radioisotope to Medical Isotope
The radioisotope must first be “functionalized” for use in detecting disease processes such as Alzheimer’s or prostate cancer. This involves equipping the radioisotope with a substance that can recognize the disease process, often proteins or antibodies to which the radioisotope can be attached. Nuclear medicine also offers another unique possibility: once a substance that targets a specific disease process is found, a radioisotope that is lethal to cells can usually be attached to it. This allows for the treatment of tumors, forming a radioactive drug known as a radiopharmaceutical.

Research into such substances mainly takes place in academic hospitals and pharmaceutical companies. Hospitals often find it challenging to develop their laboratory research further for patients, especially when larger patient groups are involved. The capacity within hospitals is often insufficient, and pharmaceutical companies may not yet find it worthwhile to collaborate in this area. Therefore, it is crucial for the various disciplines involved in producing radioisotopes and manufacturing drugs to collaborate and have the necessary facilities. Only then can radioisotopes be turned into high-quality medicines or medical devices (such as radioactive beads for liver tumors). These end products will provide significant patient benefits and substantial opportunities for Dutch economic growth.

Turning Challenges into Opportunities
To fully capitalize on the current field’s opportunities, it is essential to complete and strengthen the nuclear chain ecosystem in the Netherlands. Faster access to innovative therapies for patients, strengthened public health through data-driven policy development, economic growth through innovation valorization, and enhancing the Netherlands as a global hub for nuclear medicine.

Future investments are crucial for the future of nuclear medicine in the Netherlands and worldwide. By investing in infrastructure, collaboration, and innovation, the Netherlands can play a leading role in this rapidly growing sector. The benefits are clear: improved patient care, substantial economic growth, and a strengthened global position. While the discontinuation of the National Growth Fund presents a significant challenge, it also offers an opportunity to demonstrate resilience and creativity in finding new paths to success. It is time for the Netherlands to harness its potential and show the world what we can achieve in nuclear medicine.