There is no stranglehold. It's being manufactured for peanuts everywhere that is not USA.
That country suffers from no central negotiating body to drive down the price, and a manufacturer/insurer virtual cartel. In other countries, government either negotiated a good price, built or subsidized a quality factory.
The remaining people who have problems are in parts of global south for various reasons, some of which involve exploitation and others bad government or warfare, leading to lack of resources and experts.
That country suffers from no central negotiating body to drive down the price, and a manufacturer/insurer virtual cartel. In other countries, government either negotiated a good price, built or subsidized a quality factory.
The remaining people who have problems are in parts of global south for various reasons, some of which involve exploitation and others bad government or warfare, leading to lack of resources and experts.