No one in their right mind would build manufacturing from scratch. Contract manufacturers exist to do relatively cheap design work in exchange for access to their expensive-to-build (but cheap to use by comparison) manufacturing facilities.

I can't speak to drug manufacturing, but I know from experience that when it comes to medical devices, you save almost 10x in up front fixed cost by outsourcing, like California is doing. You spend more per unit, but still profit, so you can build a healthy warchest while you accumulate experienced personnel to build out a more vertically integrated manufacturing process.