How India and Egypt are building resilient pharmaceutical ecosystems

Authors: Titus Kisangau K, Mariam Ghobrial, and Syeda Aiman Rizvi

 Access to quality, affordable, and timely health products is fundamental to achieving Universal Health Coverage (UHC). Yet across many low- and middle-income countries (LMICs), pharmaceutical systems remain vulnerable to regulatory fragmentation, import dependency, supply chain disruptions and limited local manufacturing capacity – weaknesses that became even more visible during the COVID-19 pandemic and subsequent global supply disruption. 

Across emerging economies, policymakers and industry leaders are increasingly asking how to build pharmaceutical ecosystems that are not only efficient but also resilient, equitable, and responsive to population needs. Experiences from countries such as India, and Egypt demonstrate that progress requires coordinated action across regulation, local production, market shaping, and strategic purchasing. 

This blog distills practical, experience-based lessons from these countries, highlighting policy choices and institutional reforms that can inform national strategies and strengthen pharmaceutical resilience in support of long-term health system goals.

Building resilient pharmaceutical ecosystems requires more than expanding production; it demands deliberate system-wide alignment. At the foundation are strong and trusted regulatory systems that ensure quality, safety, and efficacy while building domestic and international confidence. Regulatory reliance and harmonisation reduce duplication, accelerate approvals, and promote regional cooperation. Investing in local and regional manufacturing capacity helps reduce dependence on imports and strengthen supply security.

Resilience also depends on sustained technology transfer and workforce development, enabling countries to move up the value chain. Meaningful public–private collaboration, anchored in quality and affordability, ensures industrial growth remains aligned with public health priorities. Together, these elements create pharmaceutical ecosystems capable of supporting long-term health system resilience and universal health coverage.

India 

India’s experience illustrates how long-term, phased policy alignment can transform a pharmaceutical sector. Over several decades, India moved from import dependence to global leadership. 

• • India aligned patent law reforms, most notably the Indian Patents Act of 1970, with industrial policy to strengthen domestic manufacturing capacity. Public investment created a foundation for local production, while later trade and intellectual property adjustments enabled private sector expansion and global integration. 
  • Over time, regulatory strengthening through the Central Drugs Standard Control Organisation and compliance with WHO prequalification standards enhanced international credibility.
  • India simultaneously invested in vaccine and biologics innovation, with manufacturers such as Serum Institute of India becoming central to global supply. 

Today, India accounts for roughly 40% of global generic medicine supply and approximately half of global vaccine demand by volume.This trajectory demonstrates that resilient pharmaceutical ecosystems are built through regulatory credibility, strategic industrial policy, technology transfer, and sustained public-private collaboration, reinforcing both national preparedness and global health security.

Egypt

Egypt has strengthened its pharmaceutical resilience through deliberate regulatory reform and industrial strategy. By linking regulatory credibility with production strength, the country is positioning itself as a regional pharmaceutical hub serving Africa and the Middle East for technology transfer, localised production, and pharmaceutical innovation, reinforcing both national health security and regional supply resilience.

• • A major milestone was achieving WHO Maturity Level 3 for its national regulatory authority, signalling a stable, well-functioning, and trusted system aligned with internationally recognised standards. This recognition enhanced international confidence and positioned Egypt as a credible regulatory actor in the region.
  • The country adopted the Common Technical Document (CTD) format for medicine registration, streamlining approvals and aligning with international best practices. It also introduced advanced track-and-trace systems to combat falsified medicines and strengthen supply chain transparency. Through regulatory reliance agreements, Egypt has accelerated product approvals by leveraging trusted international assessments.
  • Beyond regulation, Egypt has invested heavily in domestic pharmaceutical manufacturing capacity, supporting both local demand and export ambitions.

Key Cross-Country Lessons for Building Pharmaceutical Resilience.

Low- and middle-income countries should adapt, based on their own priorities and capacities and not replicate any model. Universal Health Coverage (UHC) reforms with an aim for sustainable financing, encouraging local production, and expanding access to essential medicines are key drivers in shaping pharmaceutical markets.

• • Practical steps include starting with formulation manufacturing before moving to APIs, prioritising essential medicines aligned with national disease burdens, and using public procurement to create predictable demand,
  • Early investment in regulatory and quality systems is critical, alongside a strong focus on patient-centred affordability to ensure improved access,
  • Improving procurement and demand forecasting, 
  • Promoting local manufacturing through technology transfer and workforce development.

This blog draws on insights shared during the webinar “Building Resilient Pharmaceutical Ecosystems for Universal Health Coverage in Low- and Middle-Income Countries,” held on 15 January 2026 and organised by ACCESS Health International and the Joint Learning Network for Universal Health Coverage. Learn more about the webinar here.

About Authors:

1. 1. 1. Titus K Kisangau – Communications Lead, The Joint Learning Network for Universal Health Coverage (JLN),
      2. Mariam Ghobrial, – Lifesciences Manager, ACCESS Health International, Egypt,
      3. Syeda Aiman Rizvi – Research Manager, Middle East & North Africa Regions, ACCESS Health International.

The authors are thankful for editorial review by Dr. Rahul S Reddy Kadarpeta, Executive Director, JLN.