Biotech hit rock bottom last spring as DOGE ran rampant and President Donald Trump beat the drum for historic tariffs. So for our second-half survey of biotech execs, largely CEOs, we dove right into the C-suite’s thoughts on the year ahead. How are they feeling about biotech as they plan for the next 12 months?
By and large, biotech’s fiesta days remain a distant memory. But it’s not as bad out there as it has been.
For all the disruption in Washington and a rapidly spinning door at the FDA, this year has seen some remarkable dealmaking and a clear signal from Big Pharma that they’re ready to pay for a shot at new drugs. Long a whipping boy on Wall Street, some broad-based evidence of a market bump contributed to a change in sentiment from the dark, early days of the year.
That all clearly helped — a lot — when it came to improving sentiment in the C-suite. This time around, we drew responses from 77 execs.
Challenges remain, of course. We’re several years into an industry rout that shattered market caps and blighted generalists’ interest. Setbacks in 2025 seemed more painful and harder to endure after years of a downturn. But the XBI has risen significantly, and there’s a sense reflected in the numbers that CEOs will have some fresh advantages to work with in 2026.
Biotech has been through tough times before, but the most recent downturn has tested the resolve of the most grizzled veterans.
In
our executive survey in May
, it was clear that the discontent ran deep. Biotechs were running out of money, a multitude were trading below cash, any recovery seemed uncertain and IPOs had slipped beneath a tempestuous surface.
The second half hasn’t been a cake walk, especially given the uncertainty around the FDA. But M&A heated up, a few data hits helped boost interest in the sector, and drug approvals have been coming through.
So how is the C-suite feeling today?
Cautious optimism might be the best way to characterize forecasts for 2026. One in 5 are feeling “much better” about the economics of drug development next year. And right at half are in the “somewhat better” camp — the largest concentration of execs.
Another 20% are expecting another year pretty much the same as this one, with the remaining 10% scattered largely among the “somewhat worse” to “much worse” groups.
For longtime biotech leader John Maraganore, signs of progress are a pure relief.
After a long, bleak winter, I can finally see some green shoots from incrementally lower interest rates, removal of the MFN worst nightmare overhang, and easing of tariff fears. For God’s sake, innovation needs this break!
— John Maraganore, JMM Innovations and Founding CEO Alnylam Pharmaceuticals
Among the most upbeat, you’ll find some joy at the surge in the XBI and a few pumped fists over the big numbers turning up in new deals.
If the recent momentum in public markets are sustained following the JPM Week into the first quarter of 2026, I would expect 2026 to see continued health in terms of both private and public investment, deal flow and valuations.
— Chris Garabedian, CEO Xontogeny
Renewed deal activity suggests the worst is behind us. 2025 was a turning point. Good assets will still continue to fetch strong valuations.
— Clifford Stocks, CEO OncoResponse
The recent M&A surge has started to recycle capital and I am more optimistic that the IPO market will be more robust in 2026. Macro uncertainties will remain, but it feels like 2026 will be a stronger year than 2025.
— Anonymous
If there’s one giant fly in the ointment, it’s the unending drama at the FDA. After years of steady regulatory oversight, there is now a parade of internal conflicts as almost all the senior leaders have either been booted out or fled.
The Trump administration has embarked on an effort to dislocate and disrupt the entire FDA and accordingly the core regulatory body of our industry. This will have profound impact and many companies will be affected directly and indirectly. This will accelerate through next year and long-term provide real instability.
— Anonymous
The disastrous choices for leadership in FDA and the subsequent uncertainty created will create an overhang on all biotech products. The only way this changes is if Makary and Prasad and all the unqualified underlings they have brought into the FDA are all walked out with security officers and a cardboard box for their belongings.
— Anonymous
Not everyone subscribes to the notion that turmoil at the FDA will blight the field. Some see steady hands still in play at the agency. Also, the landscape isn’t the same for all players. Some are benefiting, others aren’t.
While the FDA is being very collaborative and creatively entrepreneurial with cell therapy (the GOOD news is the FDA listened during the listening sessions), the investor community has moved onto other shiny objects with no proof of concept (the BAD news) ..all data from all modalities may be here in ’26, but in the meantime many cell therapy companies are trading below cash.
— Paul Hastings, CEO Nkarta
And there are a few execs who aren’t making plans according to any solid sense of direction. It’s been too sour for too long for them to bet on a turnaround and a rising tide that will lift all boats. For those, it’s best to plan for the worst and hope for the best.
I try to always do our planning on top of an external landscape that is the worst it’s ever been. Then anything better is upside and we work harder to not be dependent on good times and the largesse of the markets or partners, etc. And Buffett taught us all years ago that there is no way to project macro or future.
— Anonymous
These days, major changes at the FDA have become a constant. Each week seems to bring to light some new disruption. Nevertheless, while we were well into gathering responses to our survey, it was disturbing for many to see Rick Pazdur — who had steered cancer research oversight with a firm hand — suddenly exit from his recent jump to head of CDER.
But the consensus of the group had already gelled around a key point: Whatever drama was being played out in the FDA’s top group, after deep staff cuts at the beginning of the Trump administration, most hadn’t experienced a material delay or disruption at the hands of regulators.
At least not yet.
Well over half said no to the question. Another 1 in 5 said it was too soon to tell. Eight percent were N/A. And only 15% counted themselves on the directly affected side. That was up, by just a bit, when we asked the same question in May.
Some say the FDA experience has improved.
Our day-to-day interaction with FDA is unchanged. On the contrary, some reaction times have been shorter than before, possibly due to our RMAT designation.
— Anonymous
Interactions have been faster and with better focus.
— Anonymous
To the contrary, I, a moderate Dem, must admit that both Dr Makary and Prasad have listened at the listening sessions and helped cell therapy companies with special programs for these innovations…no delay, indeed speeding up of our enrollment and enabling a path to pivotal post dose escalation…NO COMPLAINTS here about FDA, other than I wish they had not fired all those people, and I think the ultimate boss RFK, is not the right person to head up HHS, given his anti-vax and anti-science approach.
— Paul Hastings
Even though the critics are in the minority, their complaints are bitter.
Our company along with many other has experienced total dysfunction at the FDA. There is complete lack of leadership and accountability. The FDA has lost sight of the collaboration required to create innovative medicines. They risk losing all credibility if they do not institute change.
— Anonymous
FDA has failed to review responses as required by law and made rulings or issued CRLs without fully reviewing material. Their habit of causing multiple precipitous delays and backtracking on understandings is going to harm companies combined with the clown show leadership communications which further destabilizes the regulatory environment. The fact that Makary, Prasad and their two deputies are Arnold Ventures people suggests that a political organization has fully infiltrated and is controlling a government function.
— Anonymous
Back in May, when I was taking the pulse of biotech’s CEOs, Marty Makary had recently stepped into the top spot at the FDA at a time the agency was getting DOGE’d. There was a lot of trepidation about what was to come, but execs were largely willing to give Makary a pass — for the time being. Some 60% reserved judgment on his leadership abilities.
Since then, CDER chiefs have come and gone faster than Internet memes, Vinay Prasad exited the top post at CBER in a huff — and immediately returned in an equally excitable state. And Makary has suffered a dramatic fall in the eyes of many in biotech’s executive class.
Now, only 28% of the Endpoints 100 have no opinion yet on whether they disapprove or approve of Makary’s role. And 40%, the largest group, disapprove of his performance as commissioner. And one-in-three approve.
Those disapprovals come with a load of negative pronouncements. Here’s one:
Makary has become the single most disastrous appointment to FDA or any HHS department in the history of the federal government.
— Anonymous
Biotech execs as a whole have long had issues with individual decisions made at the FDA, especially if they were being overruled on issues like trial designs and approval requirements. But they were also dealing with a set of regulators who had become highly experienced at their jobs and generally got high marks for doing it well. “Well,” in this business, meant building public confidence in approved drugs and being clear about what it took to get there.
For many, those days are long gone. For some, it’s a political apocalypse:
Chaotic, political aims superseding good science and reliable process.
— Anonymous
I was open-minded at first and believe his intentions are good, but his leadership has now become a disaster! We need stability, consistency, and a trustworthy Agency leadership!
— Anonymous
The inexperience of the leadership and their clear intrusion and introduction of political evaluations versus medical and science is a catastrophic disaster for the industry, the United States and the national security of our nation. This has opened up massive instability within FDA unpredictable from them, and as a consequence, they have specifically begun to destroy and dismantle our industry.
— Anonymous
Much of the backlash has to do with the people that Makary has recruited for top positions.
Too political, too erratic, poor choices for head of CBER and original head of CDER.
— Anonymous
Makary himself, though, gets a significant amount of respect — especially from the one in three who still approve of his performance.
Makary himself seems completely fine and FDA has largely been functioning fine, but the drama has been unhelpful!
— Anonymous
Underlying the criticism is disappointment that many of the public plans Makary had to modernize drug development haven’t been realized amid the current disruption that afflicts the Trump administration. If he manages to follow through on that, he could likely restore considerable faith in his role.
The ongoing politicization of the FDA and loss of key talent have made the FDA weaker. Some of the modernization approaches that Mackary has advocated for are promising.
— Anonymous
Marty Makary appears genuinely interested in making innovative therapies that have life-changing impact on patients accessible in a faster and more cost-efficient way.
— Anonymous
And don’t forget the 28% with “no opinion.” In many cases, that includes executives who still believe it’s too early to pass judgment on the Makary era. Depending on which way that group breaks over the next year, Makary can still either come out ahead or go down in the industry as the worst FDA commissioner in its history.
If there are mixed feelings about Makary, there’s no ambivalence at all when it comes to Robert F. Kennedy Jr. Feelings run hot when it comes to the HHS chief, who oversees the FDA, and they are overwhelmingly scathing.
Rounded out, Kennedy managed to eke out an approval rating of less than 2% from the survey. Ninety percent turned thumbs down, quite a few used their middle fingers, and the rest didn’t have an opinion or any digits to offer.
Kennedy’s record on upending decades of vaccine policy on the basis of dubious, at best, science, has done nothing to endear himself to the industry. And the comments, while universally anonymous, heaped insult on injury.
He is a huge threat to the nation’s health. Does not believe in science-based evidence.
— Anonymous
From there, the commentary goes downhill for Kennedy.
RFK is both incompetent and disconnected from reality.
— Anonymous
A TOTAL WHACK JOB.
— Anonymous
An unmitigated disaster from Day 1 who is meeting ALL expectations of anti-vax policy setting and quackery. Just look at Tylenol and leucovorin!
— Anonymous
On a more thoughtful tone, Kennedy is also charged with pursuing policies that are damaging the public.
The continued complete disregard of science and the replacement of longtime dedicated experts by partisan hacks is appalling, and will have longtime negative repercussions to global health from which we may never fully recover.
— Anonymous
Robert F Kennedy is a danger to the United States. It will only be a matter of time before we see massive epidemics of measles, mumps, polio, and other infectious disease diseases sweeping the United States. This is nothing short of one of the greatest public health disasters since the advent of Covid.
— Anonymous
Any member of the Trump cabinet would be unlikely candidates for adulation in biotech. Trump himself has consistently been scored over the years as politically unacceptable, hardly unexpected among a hyper-educated and relentlessly networked group of executives who are clustered in the most liberal urban areas in the country. But going into his second term, at least, Trump also garnered kudos as a plus for the industry on the business side.
Kennedy started with precious little goodwill and did nothing to help himself turn that around.
Not everyone had a raspberry for Kennedy. There was one lonely and anonymous commentator willing to stand aside from the gauntlet of criticism.
As it relates to the Biotech sector, he has not been an interloper on the Drug side of the FDA. The tropes about him get tiresome and as an anti-establishment / reform-minded appointment, it seems only those who reject any type of reform of the healthcare system/agencies hold vitriol towards him.
— Anonymous
I’ll likely pass on surveying feelings about Kennedy in our next Endpoints 100. Overall, the numbers changed little for Kennedy since the spring survey. He made a terrible first impression and has done nothing to salvage his position with biotech — though it’s doubtful that was ever a goal.
Trump often made headlines during his first tour of presidential duty with various pronouncements on his plans to slash drug prices. There was reimportation and other forms of pressure. But little changed.
This time around, Trump is still making headlines, but most of the C-suite in biotech isn’t bracing for any major changes that will affect their futures.
Asked if MFN pricing policies, IRA expansion or executive orders would materially affect revenues in the next two years, half thought it could be a “modest negative,” with 30% writing off any threat. Only about 1 in 10 predict a significant negative impact.
Worst case scenario has clearly been avoided and while prices will be lower there is a reasonable likelihood that higher volumes will offset this impact.
— Anonymous
Pharma is too powerful to cede profit. Note the rise in costs overseas in response to MFN issue.
— Anonymous
There were a few silver linings among the comments.
Onshoring of manufacturing plus rest of the world contributing more could be net positive.
— Anonymous
But a few clearly aren’t happy about what they see.
MFN will hurt the entire biotech innovation ecosystem. Executive orders are in many instances illegal.
— Paul Hastings
This will significantly disrupt, not just revenues, but transactions and deals. No biotech company will be able to do a regional transaction with any pharmaceutical company. The entire premise of the United States as a functioning and important market will be gutted by any most faded nation Klaus. At this stage already we see deal structures changing.
— Anonymous
Over the past year, dealmaking in China has reached fever pitch as Big Pharma looks for new drugs with enough human data to inspire fresh alliances. For US biotech, China has become both an existential threat as a rival for deal money and first-in-class status, as well as the land of opportunity for stealing a clinical march of their own.
There’s growing recognition that if you have a good partner in China to manage a trial, it will move faster and cheaper than anywhere else — with the potential for bundling positive data in the most efficient manner possible.
So we asked the Endpoints 100 if they were planning, conducting or at least considering a trial in China. And 42% (32 out of 76) said yes.
“If I were 30 years younger I would move my company there,” noted one seasoned vet.
Among the comments, execs were likely to talk up the advantages of a China trial. Criticism was hard to come by. Coming at a time when most biotechs are becoming expert at stretching a dollar to the max, while trying to accelerate goals, it’s clear that there are many biotech execs who see China as a direct path to the inside track.
Timeline to data is faster. There are elements of China that the US needs to consider with a policy response if it intends to remain competitive. There are also elements that we should learn from and get better (cmc and pharm/tox requirements pre-ind; study start-up simplification related to distinct IRBs and contract negotiation; dosing staggers with no basis in science).
— Anonymous
China’s policy on getting human data in early investigator trials creates a huge advantage for sponsors that pursue these approaches.
— Anonymous
Until we create US initiatives for faster and cheaper clinical evidence generation, the China IIT pathway represents a compelling approach to accelerate bringing innovative medicines to patients.
— Anonymous
I think the Kailera / Hengrui style of fast following your Chinese partner in development and learning from their experiences has some very important benefits.
— Anonymous
Perhaps that is more remarkable considering the persistent pressure that is put on WuXi following accusations regarding its ties to the military. So far, though, it seems clear that quite a few CEOs are willing to make up their own minds about the reliability of a China drug trial, and who they should — or should not — work with. As more biotechs gain experience and share that experience with others, you can expect this trend to continue to gather speed.
We’ve been tracking hiring plans for close to 10 years now, a key measure of sentiment and growth. By and large, these execs stay focused more on recruiting than cutting, even in the big retrenchments of 2023 and 2024. So when execs’ hiring plans hit a record low in the first half of this year, I took notice.
Today, perhaps indicating a broad lifting of C-suite expectations for all things biotech, the mood has swung back to hiring mode for most. About two of three E100 execs expect to add staff. Close to a third are hanging tight with the team they have. And 6% will be handing out pink slips.
I’ve stuck with some well-known CEOs for the survey, with a focus on long track records. Perhaps that has kept the Magic 8 Ball more likely to float up a “hiring” response for the survey. But whatever the cause, there’s been a definite shift back to beefing up teams in the E100.
The sentiment on investments, though, continues to run on the downside.
A third of the respondents to the survey counted the flow of investments from venture groups into biotech as fair. That’s the biggest group. Then 26% see a sour mix of investments, coming in at “poor.” Only about one in four saw the investment scene as “good,” with most of the remaining votes on the “average” size. One hardy soul came in as a hearty “excellent.”
That’s not a lot to brag about, but it’s a party atmosphere compared to last spring, when a record 60% of the execs rated the flow of investments as poor.
IPOs are still a rare sight on the biotech landscape, and no general recovery is likely before fresh money starts to flow into startups, allowing the specialists to pay their backers and recycle cash.
The largest group of biotech execs lands in a “poor” ranking for IPOs and follow-ons. Another 35% rate it as fair. One in 10 thinks it’s good.
Six months ago, the overwhelming majority of the E100 just gave the field a poor rating — another record low. So while sentiment remains guarded, at best, it’s a lot better than the rock bottom we visited.
If there’s one main task that falls to the CEO, it’s making sure that the financial runway is long and secure. So when doubts about accessing capital surged earlier this year, it raised some serious issues about sustainability.
Those concerns, though, appear to have been alleviated in the last six months, with the usual solid majority counting themselves somewhat to extremely confident on that key point. That 35% of the execs in the “very” to “extremely” confident camps is the highest rate I’ve seen since the second half of 2021, as the party music was fading in the industry.
With 84% of execs gauging biotech valuations as low to average, you wouldn’t say that there’s a lot of unfettered enthusiasm on that score. But a big drop in the bleakest category indicates once again that the money blues aren’t as big an issue as they had been in the spring.
One of the biggest boosts we’ve seen this month came on our regular question on M&A. Here, you can see the trend lines have pointed to some cheering, triggered by a string of deals — including an auction round for Metsera. The last six months of deals include several in the $10 billion-plus category. Nine out of 10 top biotech execs are solidly enthusiastic about the M&A scene in 2026.
Traditionally, we’ve also seen peak enthusiasm for M&A around JP Morgan, which lies just ahead. So these numbers should make for a more upbeat tempo in San Francisco.
Outsourcing is a constant in biotech, especially when biotechs are economizing and counting on lean staff. And it remains very stable. Most of the E100 say outsourcing will stay flat in 2026, with one in three expecting a jump. Only one respondent pointed thumbs down.