The numbers are sobering. Radioactive iodine-131, the oldest, cheapest, and most established radionuclide therapy—used to treat differentiated thyroid cancer—is available in only 28 of 54 African countries, or 51.9 percent. More advanced theranostic agents fare far worse. Lutetium-177-PSMA, a radioligand therapy approved by the U.S. FDA in March 2022 for metastatic castration-resistant prostate cancer, is offered in just seven countries (13.0 percent). Lu-177-DOTATATE, used for neuroendocrine tumors, reaches six countries (11.1 percent), and I-131-MIBG for neuroblastoma is available in only three (5.6 percent). Bone palliation agents such as strontium-89 and samarium-153 reach just five countries.

These gaps collide with an escalating disease burden. According to GLOBOCAN 2022 data cited in the review, Africa records approximately 1.19 million new cancer cases and 764,000 cancer deaths annually. The International Agency for Research on Cancer projects that figure will climb to 2.1 million new cases per year by 2040—roughly a doubling. The continent’s cancer mortality-to-incidence ratio stands at 0.64, more than double North America’s 0.29, a statistic the author attributes to late-stage presentation and inadequate treatment access. Prostate cancer, the third most common malignancy in Africa with about 106,000 new cases in 2022, is precisely the disease that Lu-177-PSMA targets—yet it is addressable with that therapy in only a seventh of the continent’s nations.

The review’s most striking contribution is its economic modeling. The author compared the cost of locally produced radiopharmaceuticals against imported agents, normalizing all figures to 2025 U.S. dollars. The results are dramatic: locally produced Lu-177-PSMA costs between US$1,500 and US$3,000 per cycle, while the imported version runs approximately US$42,500—a cost reduction ratio of 1:28.3, equivalent to a 93 to 96 percent saving. Lu-177-DOTATATE shows a similar pattern, dropping from US$35,000 imported to US$2,000–4,000 locally produced. Even radioiodine, the workhorse therapy, becomes 85 to 97 percent cheaper when made domestically. A sensitivity analysis across low, base-case, and high-cost scenarios confirmed reductions of 90 to 97 percent throughout.

The model’s assumptions are laid out in detail. Local production costs were derived from NTP Radioisotopes-published African market pricing and European cost-utility analyses, while imported costs came from published trial supplementary data. The model assumes cyclotron production with specific activity of 3.0–5.0 TBq/mg per IAEA technical specifications, facility setup costs of US$15–25 million amortized over 20 years at 500 doses per year, and regulatory and cold-chain overhead of 15–25 percent of production cost. The author is careful to note that the headline 10-year investment estimate of US$545–995 million is a modeled planning-range projection derived from IAEA unit costs and published benchmarks, not an empirically measured figure.

Workforce shortages emerge as perhaps the deepest constraint. Africa has approximately 0.18 nuclear medicine physicians per million population, based on 247 registered physicians across 29 surveyed countries extrapolated to the continental population using UN 2024 estimates. Europe, by comparison, has 3.1 per million and North America 4.2—a 17- to 23-fold disparity. Reaching even a conservative target of one physician per million would require roughly 1,400 specialists; the current deficit exceeds 1,150. More than 70 percent of existing nuclear medicine physicians are concentrated in just four countries—South Africa, Egypt, Nigeria, and Morocco—leaving 50 nations with minimal or no specialist coverage.

Infrastructure tells a parallel story. Three countries—South Africa, Egypt, and Morocco—account for the majority of the continent’s nuclear medicine capacity, achieving 0.8 gamma cameras per million population. The continental average is 0.12 cameras per million, far below the IAEA minimum recommendation of 1.0. Most starkly, 31 of 54 African countries have no nuclear medicine facilities whatsoever. The continent has an estimated 145 SPECT/CT systems, 38 PET/CT scanners, and only 8 cyclotrons—the particle accelerators needed to produce radionuclides locally.

The clinical stakes are concrete. Radioiodine therapy for differentiated thyroid cancer achieves 10-year survival rates exceeding 90 percent when available, meaning its absence in 26 African countries represents a preventable mortality burden. Lu-177-PSMA extended overall survival by a median of 4.0 months in the landmark VISION trial, and actinium-225-PSMA has shown further promise in the multicenter WARMTH Act study. Lu-177-DOTATATE significantly extended progression-free survival in the NETTER-1 trial for neuroendocrine tumors. Bone palliation with Sr-89 or Sm-153-EDTMP provides effective symptom control for painful metastatic bone disease, yet remains available in only five countries—an enormous palliative care gap with direct quality-of-life implications.

Based on the quantitative evidence, the review proposes a phased strategic roadmap for 2026 to 2036. Phase one (2026–2028) would expand radioiodine therapy to 35 countries and establish three regional cyclotron hubs. Phase two (2028–2031) would introduce Lu-177 therapies in 15 countries and install 50 new SPECT/CT systems. Phase three (2031–2036) targets one camera per million population in 15 countries and AI-integrated reporting in 20. Rwanda’s planned cyclotron launch in early 2026 and South Africa’s established NTP Radioisotopes production infrastructure are cited as proof of feasibility, with an East African hub model—Kenya supplying Uganda and Tanzania—offering a scalable template modeled on pharmaceutical supply chains.

The author acknowledges limitations: the review was conducted by a single author without independent dual screening, infrastructure data rely heavily on one 2026 survey covering 29 countries, cost estimates may not capture regional pricing variation, and comprehensive workforce registries covering all 54 nations do not exist. Twenty-eight percent of included studies carried moderate-to-high risk of bias, though a sensitivity analysis excluding high-bias sources did not materially alter the primary conclusions. Still, the central message stands: radionuclide therapy availability in Africa is profoundly inadequate relative to disease burden, but economic modeling demonstrates that local production and regional hub models can cut costs by more than 90 percent—making these therapies economically feasible for resource-limited settings, provided political will and initial capital investment are secured. Under the proposed therapy-first framework, radioiodine (low cost, high burden) and Lu-177-PSMA (high cost, rising burden) emerge as the highest investment priorities.

Subject of Research: Availability, accessibility, and economic feasibility of radionuclide cancer therapies across Africa

Article Title: Availability, accessibility, and economic feasibility of radionuclide therapies in Africa: a systematic review and quantitative infrastructure analysis

Article References: Ibrahim, E. A. (2026). Availability, accessibility, and economic feasibility of radionuclide therapies in Africa: a systematic review and quantitative infrastructure analysis. Frontiers in Nuclear Medicine, 6, Article 1825650. https://doi.org/10.3389/fnume.2026.1825650

Image Credits: AI Generated

DOI: 10.3389/fnume.2026.1825650

Keywords: radionuclide therapy, nuclear medicine, Africa, Lu-177-PSMA, radioiodine I-131, theranostics, cancer burden, radiopharmaceuticals, health economics, workforce shortage, cyclotron infrastructure, IAEA Rays of Hope