Over a period of time, a tier of mostly middle-income developing countries has developed a considerable pharmaceutical and vaccine production capacity. However, outcomes have not always been positive for domestic manufacturers in developing countries. Economic and health lessons learned from vaccine manufacturing in developing countries include challenges and positive spill-over effects. Evidence for this rapid review is taken from the south and southeast Asia (India, Indonesia, Thailand, Vietnam), and Latin America (Brazil, Cuba, Mexico). Although data on locally manufactured drugs on the balance of trade was available, this was not readily available for vaccine manufacturing. The evidence used in this review was taken from grey and academic literature, as well as interviews with economic specialists. Although market reports on vaccine production are available for most of these countries, their data is not in the public domain.