2025 has been a strange year for biopharma. The sector moved from one of the worst IPO droughts in recent memory to a high-profile bidding war between pharma heavyweights racing to break deeper into obesity. Lilly became the first drugmaker to break the $1 trillion valuation barrier, later-stage biotech’s who survived the “cleanse” from recent years, who have advanced clinical pipelines re-engaged investors and locked in meaningful financings. Earlier-stage teams however, still struggled to convert roadshows into term sheets. The result is a market of haves and have-nots where access to capital, influential data and talent has diverged sharply.

At the time of writing, the XBI is up roughly 30% year-to-date and there is a renewed sense of cautious optimism heading into 2026. But momentum alone won’t solve the leadership challenges emerging as companies shift from survival mode to scale mode. Over the past few weeks, we spoke with biopharma CEOs, investors, R&D leaders and board members on both sides of this divide. Their message was clear: the winners will be the leaders who resolve a set of paradoxes that become sharper as organizations evolve.

What follows is a field guide to those paradoxes and how high-performing teams are managing complexity, growth and decision-making in an increasingly optimistic, yet still uneven, market.

FIELD GUIDE TO NAVIGATING GROWTH IN BIOPHARMA IN 2026

1. SCALE vs SPEED

Agility doesn’t disappear in one dramatic moment; it erodes slowly through unnecessary bloating, unclear priorities and leaders drifting away from day-to-day reality. Organizations that stay quick on their feet treat frugality and focus as disciplines. They “right-size” resources rather than staff for comfort and keep decision-making close to the action so leadership never loses its feel for what’s actually happening on the ground.

One powerful tool to implement is a tight execution rhythm: a small set of quarterly priorities, reviewed frequently as a team, with slippage surfaced early rather than discovered too late.

Agility is preserved when leaders treat hiring, onboarding and culture-building as core work, not a side activity squeezed between board decks and investor calls. Over time, culture becomes defined not by perks or branded gilet’s but by how decisions get made, who gets heard and how quickly teams can adapt.

“I use Objectives & Key Results, a practice I’ve carried from my last company into Vicore. We pick a limited set of the ten or so most important things to accomplish, then track them with the leadership team every other week. It becomes a North Star: if goals are on track, great; if not, we see issues early and can intervene before something slips significantly.”
— Ahmed Mousa, CEO, Vicore Pharma

2. SCIENCE-FIRST vs MARKET-READY

Being genuinely science-first doesn’t mean ignoring commercial realities. High-performing leaders design programs where scientific durability and product viability are aligned from day one. Early on, the focus should be mechanism, translational logic and biological proof. But once assets move into the clinic, the questions must expand: Where does this sit in the treatment paradigm? What does differentiation actually look like? Can we win here?

Externally, discipline matters. More leaders now adopt a “data before dreams” posture resisting the temptation to oversell preclinical stories and instead scaling the narrative when clinical activity appears and partners can trust the signal. Internally, they ensure R&D teams understand payer expectations, competitive threats and market-access implications without turning scientists into salespeople.

The goal is simple: do great science in ways that matter to patients, prescribers, and partners.

“Making a good plan, one that tells a strong commercial story and has scientific durability from the beginning, is what I feel is the best recipe for success - Can I scientifically prosecute this and can I make a product that will be commercially viable?”
— Heike Keilhack, Head of Oncology Drug Discovery, Takeda

3. GLOBAL REACH vs LOCAL SOUL

A U.S. presence is becoming essential for many European companies, but expansion only works when it is purpose-driven, staged and culturally coherent. Successful leaders treat U.S. listings, offices and hires as tools to advance the business not badges of prestige. They start lean with senior talent, then expand as data, market conditions and organizational readiness align.

The harder part is cultural. As teams spread across Europe, the U.S. and other geographies, companies must protect the elements of their original DNA while embracing the speed and accountability of the U.S. market. The best organizations make this a strength: European (or global) R&D depth and talent stability paired with U.S. capital access, commercial input and scale.

“One of the biggest difficulties as you scale up is keeping the core elements of what made you successful in Europe while expanding toward the US and attracting US talent to reinforce the capabilities needed. Finding the right balance between the original culture and U.S. culture is probably one of the most difficult things for a CEO.

“In our case, Abivax was essentially 100% French two years ago and now we are about 50-50, which naturally creates challenges. But this is why HR and managers play an important role in finding the best of both worlds and sharing values that are ‘transfrontier’—values that can be expressed wherever you operate”
— Marc de Garidel, CEO, Abivax

4. SPECULATE vs ACCUMULATE

The market still rewards bold science, but only when it is paired with disciplined capital allocation. Leaders who navigate this paradox insist that every “double-down” moment is driven by data, not optimism or market sentiment. Companies should run multiple programs lean, generate early signals and concentrate resources on the winners. Ambition is expressed not just by starting big ideas, but equally by walking away from programs that no longer make sense.

Effective operators are ruthlessly clear about the company’s North Star, the indications being pursued, the rationale behind them and the commercial route to market. They use that clarity to decide when to double down, when to pivot and when to stop.

“For me, the balance between speculation and accumulation is always data-driven. In biotech you have to be frugal, because the money isn’t yours, it’s the investors’.  so you only scale up when the data truly justifies it.”

“Even if something looks promising, if the data or competitive landscape doesn’t support further investment, you need the discipline to kill or deprioritize it”
— Martin Welschof, CEO, BioInvent

5. DEAL OR NO DEAL

Partnerships are built through long-term dialogue, realism and trust. Leaders who excel here engage potential partners early, invite scientific feedback and build relationships long before a deal is needed. They acknowledge the skepticism created by overcrowded markets or overhyped assets and deliberately work to be the counterexample: consistent, transparent, evidence driven.

At the same time, companies should behave as if they will launch independently. They seek optionality, not dependency. Ironically, the independence optionality provides often leads to better deal terms when the moment is right.

“Publicly saying you want to sell is not a good idea; your responsibility is to develop the drug as far as possible and if a third party comes and proposes to collaborate, then you discuss it.”
— Marc de Garidel, CEO, Abivax

6. STAKEHOLDERS IN SYNC

Boards, investors, and management don’t always operate with the same incentives or time horizons. Successful leaders are thoughtful to this and create alignment by being explicit about mission and expectations, while maintaining enough independence to make long-term decisions. Patient-centricity matters, but it doesn’t override investor realities. The work is translating patient need into value creation clearly and consistently.

“Stakeholder alignment really starts with being ruthlessly clear-eyed about the strategy — what problem you’re solving and why it matters  — and making sure that north star is distilled for the board, investors and management. You must stay transparent when data shifts and be explicit about whether new information represents an ‘and’ or a true pivot, because clarity is what keeps everyone anchored.”
— Chris Roberts, CEO & Founder, stealth biotech

7. RAISING WITHOUT LOSING

Financing isn’t just about the money. It is about quality, timing, runway, and control. Leaders who navigate this effectively accept that dilution is not the enemy, running out of cash is. They target investors who understand their science, support later-stage complexity and have the conviction to stay through volatility.

Time IPOs, follow-on offerings, and private raises around clear catalyst maps rather than market noise

A constant tension is managing investor philosophy: U.S. funds often push for larger raises and risk; European investors favor conservation and precision. CEOs must articulate a strategy that accommodates both without compromising mission or control.

“You don’t die from dilution; you die from not having enough cash. If you go too fast to public markets, the investor base are very demanding in catalysts and milestones and without short-term data to communicate within a year you’re not doing well in public markets.”
— Marc de Garidel, CEO, Abivax

8. CHINA: EMBRACE OR RACE

China has moved from a peripheral consideration to a central lever in global development strategy. Today, China’s biotech sector is up 110% year-to-date, fuelled by a record surge in outbound innovation. In the first eight months of 2025, Chinese drugmakers executed 93 overseas licensing deals worth $85B, signaling that China is becoming a global discovery and development powerhouse.

Western companies are now looking east to compress timelines, access dense patient populations, reduce cost, and tap a rapidly scaling scientific ecosystem.

“Openly leverage China as a high-velocity clinical engine—compressing timelines, reducing cost, accessing dense patient populations and combining Western molecule rigor with Eastern execution speed through east-west or west-east asset exchanges.”
— Sascha Berger, Independent Investor & Advisor

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