<p>The outbreak of COVID-19 pandemic exposed the fragility of global health systems especially in the developing world. Global disparities in the readiness to respond to pandemics were laid bare. These were manifested as lack of access to essential vaccines and therapeutics as well as challenges with cold chain including storage and transportation. As a result, various initiatives to build vaccines and therapeutics manufacturing capacity in Africa pivoted around Africa Centers for Disease Control and Prevention (CDC) as a coordinating agency. Appropriate characterization of the continental landscape is critical to developing a response strategy for building drug and medical product manufacturing capacity. Equally, strategies from South-East Asia will inform the development of an African continental strategy. This paper advocates for the need to follow an ecosystems’ approach to building drug manufacturing capacity. In practical terms, this translates in simultaneous investment in research and manufacturing infrastructure, establishing a biotech incubation supportive system, nurturing contract research organisations (CROs), contract development and manufacturing organisations (CDMOs), and contract manufacturing organisations (CMOs) and promoting a robust collaboration culture in the ecosystem. Partnerships with a technology partner and technology transfer partner, followed by a technology platform are essential steps in setting up a CDMO as a stepping stone to vaccine and biologics manufacturing in Low-and-Middle-Income-Countries. The role of the public sector in seeding healthcare product manufacturing capacity through PPPs or direct SOE mode is critical.</p>