This report is organized into six chapters. The first chapter provides an introduction and presents a brief situation analysis of current research and development and manufacturing capacities in the region based on detailed desk review. The second chapter describes the importance of coordination in ensuring regional vaccine security and presents different complementary pathways for achieving the AVSSR vision. The third chapter comprehensively describes the vaccine value chain in the ASEAN region, covering both backward and forward integration aspects, including logistics and delivery. The fourth chapter describes strategic priorities relevant to regional vaccine eco-system development and describes existing strengths and weaknesses within selected ASEAN countries that could influence such development. The fifth chapter summarizes findings of an economic analysis of investing in late-stage clinical trials, manufacture, and regulatory strengthening for a limited set of priority diseases. A strong economic case is made for investing at the regional level compared to the national level by using cost benefit ratios. The concluding chapter summarizes feedback from key stakeholders in both public and private sectors and utilizes this feedback to present a way forward by listing specific tasks for ASEAN member state governments, the Secretariat, and the World Bank Group.