As 2025 closes, biopharma and healthcare are learning to live on shifting ground. In this special year-end episode of "The Top Line," Fierce reporters take stock of a year defined by federal research cuts, vaccine policy fights and leadership churn at the FDA, then push the conversation forward into the questions that will shape 2026. The through line is that uncertainty has become an operating environment, and the industry is recalibrating in real time.

Fierce Biotech’s Gabrielle Masson, joined by Darren Incorvia, traces how funding decisions can narrow the pipeline years before the consequences are visible. Fierce Pharma’s Fraiser Kansteiner sits down with Angus Liu and Eric Sagonowsky to unpack the new center of gravity inside federal agencies, where vaccine recommendations, review norms and new FDA pilots are colliding with questions about capacity and outside influence. From there, Ben Adams and James Waldron bring the lens to Europe, where Jefferies in London captured a cautiously optimistic market still wrestling with tariffs, pricing pressure and investment hesitation. The episode closes with Fierce Healthcare’s Heather Landi and Paige Minemyer sharing their outlook on 2026, from the fight over ACA subsidies and Medicaid headwinds to the next phase of AI adoption, where the promise is real but the payoff may be slower, messier and more uneven than the hype suggests.

To learn more about the topics in this episode: 

• 'Unprecedented turmoil' engulfing FDA threatens public health: mRNA coalition speaks out
• FDA names Tracy Beth Høeg, fresh from vaccine safety probe, as acting head of drug center
• A dozen former FDA commissioners blast Prasad's proposed vaccine policy changes
• In letter to Makary, biotech CEOs push for FDA stability and say volatility threatens US innovation
• NIH grant cuts have disrupted hundreds of clinical trials, study finds
• 'Alternative history' of the NIH shows how a 40% budget cut may thwart new medicines
• House passes healthcare affordability bill without subsidy extension
• AMA: A look at concentration in commercial insurance, MA markets
• 2025 Outlook: Hospital finances show signs of stability, but rising costs will be a major headwind