The World Health Organization (WHO) on Friday  released an updated list of medicines that should be stockpiled in the event of a radiological and nuclear emergency, along with new policy advice in the event of such an incident.

“Preparedness for radiation emergencies is consistently reported as the weakest area of preparedness in many countries,” the 66-page report said.

This newest report updates the one released over 15 years ago, in 2007, and thus includes a host of new pharmaceutical developments. 

“In radiation emergencies, people may be exposed to radiation at doses ranging from negligible to life-threatening. Governments need to make treatments available for those in need – fast,” said Dr Maria Neira, WHO Acting Assistant Director-General of the Healthier Populations Division. 

“It is essential that governments are prepared to protect the health of populations and respond immediately to emergencies. This includes having ready supplies of lifesaving medicines that will reduce risks and treat injuries from radiation.”

Added Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme: “This updated critical medicines list will be a vital preparedness and readiness tool for our partners to identify, procure, stockpile and deliver effective countermeasures in a timely fashion to those at risk or exposed in these events.”

Radiological or nuclear emergencies could occur at nuclear power plants, medical or research facilities or be the result of accidents during transport of radioactive materials, WHO explained. In addition, these emergencies could be the result of a malicious event, such as a nuclear bombing.

To date, there were two massive nuclear incidents: The 1945 atomic bombings of Hiroshima and Nagasaki by the United States, the consequences of which have been continually studied. There was also the 1986 accident at the Chernobyl nuclear plant in Ukraine – the largest uncontrolled radioactive release in history.

Former Russian President Dmitry Medvedev warned this month in yet another Telegram post that a defeat of Russia in Ukraine could trigger a nuclear war.

“The defeat of a nuclear power in a conventional war may trigger a nuclear war,” Medvedev wrote. 

Exposure to high doses of radiation can have severe consequences on a person’s long-term health or lead to immediate or early death. As such, aside from generic supplies and materials used for any type of emergencies, stockpiles should include medicines that either prevent or reduce exposure to radiation, WHO explained. 

Only a handful of recommended medicines 

There are only a handful of specific drugs that have been proven effective in the treatment of over-exposure to radiation and these are included in the report. They include: stable iodine; chelating sand (decorporating agents); cytokines used for mitigation of damage to the bone marrow; and medicines to treat vomiting, diarrhea and infections.

“One of the most serious outcomes of over-exposure to radiation is acute radiation syndrome (ARS), which manifests as a haematopoietic syndrome”. The latter, also called bone marrow syndrome, impacts blood cell production and in cases of acute poisoning, can lead to death through infection or hemorrhage.  

“Depending on the severity of the exposure may further progress as gastrointestinal, cardiovascular and neurological syndromes,” the report states. However, the WHO recommendations only include treatments of haematopoietic and gastrointestinal syndromes, “as cardiovascular and neurological syndromes are considered non-salvageable and require only palliative care.”

Blocking agents such as stable iodine, could be used to block the uptake of radionuclides in the body, the WHO report added. Other agents like Prussian blue are applied to remove radioactive ceasium from the body. Calcium or zinc diethylenetriaminepentaacetic acid can treat internal contamination with transuranium radionuclides.

“These and other elements of such stockpiles should be made rapidly available in case of radiation emergencies,” wrote WHO. 

Bone marrow syndrome – emerging treatments

In the case of haematopoietic, or bone marrow syndrome, radiation attacks all three blood lineages – white and red blood cells and platelets. 

Low white blood cell count weakens the immune system, making an individual vulnerable to infection. Red blood cells carry oxygen to the body and platelets are responsible for coagulation, which prevents bleeding, explained Yaky Yanay, CEO and president of Pluri – an Israeli-based biotech firm developing an injection of placenta cells for the treatment of ARS. 

The treatment has been approved by the United States Food and Drug Administration as an “Investigational New Drug” (IND) for use in the event of a nuclear incident – although it is not yet mature enough to be considered for the WHO list of recommended medicines. 

The WHO report notes, however, that researchers are making progress on developing novel treatments, although none of them have been approved by the global health agency for use in a nuclear emergency. 

WHO: Stockpile based on population size

WHO stressed that a country’s nuclear medicines stockpile should be based on reliable data for national risk profiles, the size of the population and available resources and capabilities of their health system. 

Finally, WHO called on national health authorities, health-care facilities, pharmaceutical suppliers and logistics, civil defense and emergency services to be leveraged in the event of an emergency. These teams should be coordinated in advance to be able to function effectively in the event of a nuclear incident. 

Image Credits: Photo by Frédéric Paulussen on Unsplash.