The COVID-19 pandemic has highlighted the strategic imperative of building resilient manufacturing capacity for essential medicines and vaccines in developing countries and regions. There is the potential to improve availability of essential medicines and accelerate access to novel products whilst protecting the innovation ecosystems that have so rapidly developed COVID19 vaccines. Developing the assets that can achieve these ends requires an ecosystem that ensures sustainable high-quality production. Requisite components of such systems include a conducive environment that supports investment, access to markets, robust regulatory oversight, and access to technology. Africa bears a disproportionate burden of disease and is dependent on imports for many essential medicines and most vaccines. The disruption to global supply chains caused by the COVID 19 pandemic has highlighted the vulnerability of the continent and underlines the need to strengthen local production of these products. There are ongoing initiatives in this field, but accelerated progress requires a redoubling of efforts. Coordinated application of ´push´ and ´pull´ interventions could help build conducive environments and establish the market returns that will stimulate investment. The international community can play a catalytic role by targeting Official Development Assistance and Other Official Flows through a combination of capacity building, budget support, and market commitments/signalling. This adjustment will accelerate progress towards sustainable industry sectors in medicines and vaccines and lead to improved and more resilient access in Africa and other developing regions of the world.