In 2020, when biotech companies raced to manufacture COVID-19 vaccines and therapies, many discovered they could not find a factory. The contract manufacturers with the right capacity were booked years out. One name kept coming up: Lonza, the Swiss supplier that struck a deal to produce Moderna's mRNA vaccine. Moderna had the science. Lonza had something scarcer: the ability to actually make the product at scale.
This is the quiet truth of biotech and medtech. The company with its name on the drug or the device often does not control its own destiny. The supplier does.
Why upstream suppliers hold the power
In most industries we assume the brand owner sits at the top. In biotech and medtech, power frequently sits one or two steps upstream, with firms most patients and even many investors have never heard of.
The reason is simple: certain inputs are chokepoints. A chokepoint exists when there are very few qualified suppliers, switching is slow or legally restricted, and the buyer cannot make the input themselves without years of investment.
Three chokepoint types dominate the sector:
Manufacturing capacity (who can physically make the product)
Precision tooling (the machines that make the machines)
Single-source inputs (a reagent, API, or component with one real supplier)
APIApplication Programming Interface: a standardised interface that lets applications communicate and exchange data without knowing each other's internal workings.View full definition →
Let us look at each with real examples.
Chokepoint 1: manufacturing capacity (cdmos)
A CDMO (Contract Development and Manufacturing Organization) is a company that makes drugs on behalf of others. Most biotechs, especially small ones, never build their own factories. Building a biologics plant can cost hundreds of millions of dollars and take years to validate with regulators.
So they outsource. And the CDMO market for complex biologics is concentrated.
Lonza (Switzerland) is the clearest example. It runs large-scale mammalian cell manufacturing (the process used to make antibody drugs) and offers development services across the pipelinepipelineAll active sales opportunities across the stages of the sales process, together with their combined potential value and probability of closing.View full definition →. Catalent (US, now owned by Novo Holdings as of 2024) and Samsung Biologics (South Korea) are other giants.
Why does this hand them power?
Timelines. If Lonza's suitable capacity is full, your launch slips. You wait for their slot, not the other way around.
Pricing. Scarce capacity means the CDMO sets terms. Long-term "take or pay" contracts (you pay for reserved capacity whether you use it or not) are common.
Gatekeeping. A regulator like the FDA (US Food and Drug Administration) or EMA (European Medicines Agency) approves a specific facility to make a specific product. Once your product is tied to a plant, moving is a major regulatory event. That lock-in is the supplier's moatmoatA lasting edge over competitors: a resource, capability or position they cannot easily replicate, letting a firm earn above-average returns over time.View full definition →.
The tech-transfer trap
When a biotech hands its process to a CDMO, it performs tech transfer: teaching the manufacturer exactly how to reproduce the product. This is slow, expensive, and hard to reverse. Once complete, the biotech is effectively married to that facility. Switching means repeating validation and often re-filing with regulators. The supplier knows this.
Chokepoint 2: Precision tooling (the ASML analogy)
ASML (Netherlands) makes the lithography machines used to print the smallest features on advanced semiconductor chips. It is the only company in the world that sells the most advanced version, called EUV (extreme ultraviolet) lithography. Not the market leader: the only one. Chipmakers like TSMC and Samsung must buy from ASML or fall behind.
Biotech and medtech have their own versions of this "one supplier for the critical machine" dynamic.
Gene and cell therapy depends on tools like viral vector production systems and specialized bioreactors. The pool of vendors who can supply validated, regulatory-grade equipment is small.
DNA sequencing long ran through Illumina (US), whose sequencing platforms held a dominant share for years (commonly cited above 70 percent globally, an estimate that has softened as challengers like Element Biosciences, Ultima Genomics, and China's MGI/Complete Genomics entered). If your assay is built on Illumina chemistry, you buy Illumina consumables. The razor-and-blade model (cheap machine, profitable ongoing reagents) makes the installed base a recurring revenue stream.
Medtech imaging and surgical robotics concentrate around a few players. Intuitive Surgical (US) built such a strong position in soft-tissue surgical robotics (its da Vinci system) that hospitals and rival device makers plan around it.
The lesson: whoever owns the tool that everyone standardizes on captures margin quietly, sale after sale, long after the headline device is sold.
Chokepoint 3: single-source reagents and apis
An APIAPIApplication Programming Interface: a standardised interface that lets applications communicate and exchange data without knowing each other's internal workings.View full definition → (Active Pharmaceutical Ingredient) is the molecule that actually treats the patient. The rest of the pill is filler. A reagent is a substance used in a lab process, for example an enzyme used to amplify DNA.
Many drugs and diagnostics depend on a single qualified supplier for a critical input.
Enzymes and specialty reagents. Companies like Thermo Fisher Scientific (US) and Merck KGaA (Germany, operating as MilliporeSigma in the US) supply reagents that thousands of labs and manufacturers standardize on. Qualifying a second source takes time and validation, so buyers often stay single-source by default.
APIs concentrated in Asia. A large share of global APIAPIApplication Programming Interface: a standardised interface that lets applications communicate and exchange data without knowing each other's internal workings.View full definition → and key starting material production sits in China and India. The exact figures are debated, but US and EU regulators have repeatedly flagged this concentration as a supply-chain risk. When a single plant has a quality failure or a country restricts exports, shortages ripple worldwide.
Lipid nanoparticles (LNPs). The delivery system for mRNA vaccines depends on specific lipids from a narrow set of suppliers. During the pandemic, these lipids became a genuine bottleneck.
For a plain-language overview of how drug shortages arise from these chokepoints, the FDA maintains a public Drug Shortages resource.
A simple worked example: what a chokepoint costs you
Suppose a mid-size biotech reserves biologics capacity under a take-or-pay contract.
Reserved capacity: 4 manufacturing slots per year
Contracted price: 5 million USD per slot (illustrative figure, not a real quote)
Product launch delayed by regulators: only 2 slots actually needed this year
Take-or-pay means the biotech still pays for all 4 slots:
4 slots x 5 million = 20 million USD committed
Value actually used = 2 slots x 5 million = 10 million USD
"Dead" spend on unused reserved capacity = 10 million USD
The supplier collects the full 20 million regardless. That is pricing power: the risk of the delay sits with the buyer, not the supplier. Note these numbers are illustrative to show the mechanism, not a market benchmark.
Knowledge check
1. Why do upstream suppliers in biotech and medtech often hold more power than the branded company whose name appears on the product?
2. According to the lesson, which combination of conditions defines a true 'chokepoint' input?
3. Why do most small biotechs rely on CDMOs rather than building their own factories?
MULTIPLE CHOICE
4. Select ALL correct answers. Which of the following are chokepoint types identified in the lesson as sources of supplier power?
Select all the correct answers.
MULTIPLE CHOICE
5. Select ALL correct answers. What does the Lonza, Moderna example illustrate about value-chain power?
Select all the correct answers.
How this reshapes the balance of power
MapMapUsing software to automate repetitive marketing tasks and campaigns, enabling personalisation at scale across channels like email, web, and social.View full definition → the players and the picture inverts from what you might expect.
Incumbent pharma (Pfizer, Roche, Novartis) has money and marketing but frequently rents capacity and buys tooling from suppliers.
Challenger biotechs are almost entirely dependent on suppliers. A single-source failure can end a small company.
Suppliers (Lonza, Thermo Fisher, Illumina, ASML in the adjacent chip world) sit on chokepoints and enjoy durable pricing power.
Regulators (FDA, EMA) unintentionally strengthen suppliers: by tying approvals to specific facilities and processes, they raise switching costs and lock buyers in.
Distributors matter more in medtech and generics, less at the innovation frontier.
The value does not flow evenly. A large share of margin can accumulate upstream, with the "invisible" supplier, even though the branded drugmaker takes the public risk and reputation.
Signs you are looking at a chokepoint
When analyzing any biotech or medtech company, ask:
1. How many qualified suppliers exist for the critical input? One or two is a red flag for the buyer, a green flag for the supplier.
2. How hard is switching? If it requires regulatory re-filing or tech transfer, the incumbent supplier is entrenched.
3. Who bears the risk in the contract? Take-or-pay and long reservations signal supplier power.
4. Is there a razor-and-blade model? Recurring consumables lock in years of revenue.
Why it matters for strategy
Understanding chokepoints changes how you read the sector. A biotech's most important relationship may not be with its investors or the FDA, but with a CDMO in Switzerland. A diagnostics startup's fate may hinge on one sequencing vendor's consumable pricing.
Governments have noticed. Both the US (through initiatives to reshore APIAPIApplication Programming Interface: a standardised interface that lets applications communicate and exchange data without knowing each other's internal workings.View full definition → production) and the EU (through its Critical Medicines efforts) are trying to reduce single-source dependence. Whether policy can loosen these chokepoints faster than the market rebuilds them is one of the defining questions of the decade.
Key Takeaways
Power in biotech and medtech often sits upstream. The company that makes or tools the product frequently has more leverage than the company that brands it.
Chokepoints come in three forms: manufacturing capacity (CDMOs like Lonza), precision tooling (Illumina, Intuitive Surgical, ASML-style monopolies), and single-source reagents and APIs.
Regulation deepens lock-in. Because FDA and EMA approvals tie a product to a specific facility and process, switching suppliers is slow and costly, which strengthens the incumbent supplier.
Contract structure reveals power. Take-or-pay terms and razor-and-blade consumables shift risk to the buyer and lock in supplier margin.
When analyzing any player, count the qualified suppliers. One or two means the "invisible" supplier, not the brand, may quietly own the value chain.