Developing countries have traditionally been regarded as users of technology developed abroad. During the 1980s and 1990s this approach to meeting domestic healthcare needs faced new barriers to consumption and use that resulted from the high cost of drugs and the emergence of new international trade, investment and intellectual property rules. Attention was thus drawn to the possibility of building (bio)pharmaceutical innovation systems at home. By examining the experiences of india, cuba, iran, taiwan, egypt and nigeria, this paper identifies a multiplicity of pathways for doing so. Because innovation is embedded in both a policy and institutional context, country-specific triggers and drivers of innovation processes have been important. None the less, some commonalities do appear. Among the more notable triggers were the existence of healthcare crises and earlier incentives that had focused the attention of critical actors on domestic healthcare problems and stimulated a conscious effort by firms to master technology. The interactivity among four types of policies—those strengthening the knowledge base, stimulating capacity building, opening space for local firms and creating incentives for innovation were important in shaping the way these triggers were perceived and in driving the subsequent innovation process.