By Jason Campagna, CMO of Q32, as part of the From The Trenches feature of LifeSciVC
In a recent essay, I argued that biotech is entering its strategic infrastructure moment, a shift from molecule-centric innovation to a layered capability stack beneath the therapeutic. The core claim was structural: the future of biotech depends as much on what supports the drug as what is in it. And it is not just the infrastructure itself, but the way geopolitics now intersects with long-standing challenges around payers, access, and socioeconomic disparity. These pressures are not new, but they are being amplified by the global nature of supply chains, regulatory divergence, and rapidly shifting national priorities. This growing complexity gives rise to a deeper set of questions, ones that extend beyond infrastructure and markets. They concern how we build companies, how we design teams, and how we lead amid shifting forms of pressure and constraint. This essay takes up those questions, not to provide definitive answers, but to explore the contours of a new leadership landscape.
We are not starting from scratch. Over the past two decades, life sciences venture capital has developed a substantial body of data, pattern recognition, and tacit knowledge around what works in early-stage biotech. There is a rich literature and a practiced pedagogy around founding team composition, early leadership selection, and how to scale through clinical inflection points. These models have been tested, refined, and taught with real success.
But as I noted in the earlier piece, the context surrounding these models is shifting. The challenge is not to discard what we’ve learned, but to recognize when the nature of the problem changes beneath our best practices. As the landscape becomes more layered, infrastructural, and globally entangled, the kinds of organizations we build and the leadership they require may need to evolve in response.
Introduction
At this year’s Guggenheim biotech investor conference in Boston, the keynote wasn’t about drug pipelines, IPO windows, or FDA guidance. It was about special operations warfare. On stage were two Navy SEALs, members of the U.S. Navy’s elite special operations force, Mike Hayes and Britt Slabinski, speaking about leadership under pressure. The conversation was moderated by Guggenheim’s CEO. At first, it felt theatrical. Two SEALs at a biotech conference seemed out of place. But the topic wasn’t war. It was decision-making, alignment, and consequence. And something about it stuck. The message was clear: the environment has changed, and the way we lead must change with it.
Before biotech, I was a practicing anesthesiologist, then a hospital administrator. I spent years thinking about how to make high-stakes environments safer, drawing lessons from aviation and the Navy, where small errors can be fatal. That background shaped how I heard the keynote. The parallels were immediate. In medicine, as in biotech, the ground can shift without warning. But unlike medicine, biotech doesn’t pause. There is no reset between cases.
That keynote became the seed for the earlier essay. But there’s an irony I didn’t fully appreciate at the time. I focused on what was changing in the field. Only later did I begin to see how those shifts might reshape leadership itself. A capability stack is not just technical, it’s organizational. This essay isn’t meant to add to the vast literature on leadership or teaming. It’s a field note. A response. The keynote hit a nerve, and it left me thinking about what’s changing in biotech, and what that shift might ask of us as leaders. Today’s biotech companies are modular, global, and often fragile. The structures that support them, how we align, coordinate, and decide, may need to evolve as much as the science they advance. That’s the premise of this essay: not that we must reinvent how we lead, but that the context is changing in ways that make that reflection worth taking seriously.
After hearing that keynote, I did what many others might do: I went looking. A cursory search of Amazon or Goodreads reveals a vast ecosystem of books by former military leaders, special operations commanders, and crisis-tested strategists, nearly all offering frameworks for leadership under pressure. These models aren’t hard to find. They show up on business bestseller lists, in executive off-sites, and across management training programs. The issue isn’t scarcity, it’s selection.
From that broader landscape, I selected three. Not because they’re definitive, but because they feel aligned with the realities biotech leaders now face. Each was shaped in high-consequence, rapidly evolving environments. Each offers something practical when applied to the unique demands of our field. These principles aren’t exhaustive. Others could have been chosen and more will emerge. This essay doesn’t aim to settle the question. It aims to provoke it, to invite a broader conversation about how we lead when, as one of these authors put it, the terrain refuses to hold still.
Dynamic Subordination
Principle: Let the Best Information Lead
Based on the leadership framework of Mike Hayes, former SEAL Team TWO Commander
Mike Hayes introduced the concept of dynamic subordination as a response to the limits of rigid hierarchy. As Commander of SEAL Team TWO, he led operations in some of the most unforgiving and high-consequence environments imaginable: Iraq, Afghanistan, and other theaters where delay often carried greater risk than autonomous action. In those settings, success hinged less on rank and more on who had the most immediate, relevant information. Leadership had to be situational. Roles shifted based on proximity to the problem and real-time judgment.
Dynamic subordination didn’t reject structure; it required a more adaptive version of it. Hayes emphasized that speed and agility were only possible when everyone had a clear understanding of mission and intent. The leader’s role, then, was not to dictate each move, but to create the conditions where initiative could emerge from anywhere in the system without sacrificing coherence.
This resonated with me not only as a biotech operator, but as someone who spent years in acute care medicine. I thought of the experience of running operating rooms overnight in smaller regional hospitals, what Hayes might call austere environments. These hospitals aren’t academic centers; they function with lean staffing, limited resources, and personnel often spread across units. The acuity of cases can change in an instant. And often, the person with the chart isn’t the one with the clearest picture. Nurses, techs, anesthesiologists, even transport staff can hold critical insight. Recognizing and acting on that insight quickly can change outcomes. In those moments, leadership moves. It must.
That same dynamic is emerging in biotech. While the field has long operated globally, the rationale has shifted. It’s no longer just about accessing lower-cost manufacturing or early-phase trial speed. Today, discovery itself is global. Development may begin outside the U.S. and remain there through pivotal studies. Candidates originate in China, India, and elsewhere, with strategy and execution often playing out far from legacy biotech hubs.
This decentralization strains traditional command models. Forward teams are separated not only by time zones, but by differing regulatory regimes, cultural norms, and operational tempo. Decisions at the edge often outpace central systems’ ability to respond. In this setting, responsibility must be distributed deliberately. Authority must flow outward, retaining accountability while enabling action. Dynamic subordination offers a way forward. It supports models where local expertise drives decisions, anchored by a shared mission. It invites us to rethink how context is shared, how trust is built, and how authority moves, not to weaken leadership, but to strengthen it.
Shared Consciousness
Principle: Align on Purpose, Execute Independently
Based on the leadership framework of General Stanley McChrystal
General Stanley McChrystal reshaped how special operations teams functioned in a world where centralized command could no longer keep pace with distributed, fast-moving threats. As head of the Joint Special Operations Command (JSOC) during the Iraq War, McChrystal confronted a fragmented fight against decentralized insurgent networks. Traditional hierarchies—designed for linear operations—simply couldn’t respond at the speed required. His core adaptation was shared consciousness: build deep alignment on mission and intent, then empower decentralized teams to act independently.
In McChrystal’s model, autonomy wasn’t permitted despite complexity, it was necessary because of it. When everyone shares context, coordination doesn’t rely on constant oversight. Coherence replaces control. That principle has increasing relevance in biotech, particularly within platform-native companies. These organizations rarely follow a single asset path. They run portfolios across multiple programs, modalities, and often geographies. One team might be working on a cell therapy, another on RNA, another on small molecules. At the same time, external collaborators: CROs, CDMOs, academic groups, all operate on varied timelines. In this environment, the logic of a rigid command model falters. What’s needed is not tighter control, but shared context and aligned intent across teams that may never sit in the same room.
That distinction, between control and coherence, resonated with me. In acute clinical medicine, especially in trauma or critical care, proximity matters less than alignment. A trauma team doesn’t function because it reports to a single individual. It functions because each member holds a shared mental model of the situation, the priorities, and the path forward. That clarity allows distributed action without losing the thread. It was never about hierarchy. It was about shared judgment under pressure.
Biotech is moving in a similar direction. Platform companies now operate more like networks than pyramids. Yet many leadership models still assume a central cadence that no longer fits. The challenge isn’t just managing complexity; it’s distributing the ability to manage it. That starts with how we build and transmit context across teams.
Biotech hasn’t yet produced many mature examples of shared consciousness at scale. But that’s what makes the concept useful. It names a gap that is already emerging and offers a way to think differently.
Command Under Ambiguity
Principle: Lead with Intent, Not Doctrine
Based on the leadership framework of Pete Blaber, former Delta Force Commander
Pete Blaber spent his career leading Delta Force, the U.S. military’s elite counterterrorism unit,
in environments where the usual rules no longer applied; settings defined by incomplete information, shifting variables, and unstable terrain. These weren’t scenarios that rewarded rigid execution. They required a different kind of leadership: one rooted in clarity of intent, shared understanding, and the judgment to act even without certainty. Blaber’s model, shaped by the demands of high-risk missions, emphasizes that when doctrine breaks down, leadership must be anchored in purpose and informed by trust.
That same dynamic increasingly defines biotech. The exuberance of 2020–2021 has given way to a more constrained, unpredictable landscape. Across the industry, companies are making hard decisions not because their science has failed, but because the terrain has shifted. These aren’t small adjustments, and in many cases, they’re structural resets: choices to shelve lead programs, downsize teams, return capital. It’s a kind of organizational triage that can’t be navigated by process alone. What’s needed is a leadership model that can absorb ambiguity without being paralyzed by it.
I saw this firsthand at Q32 Bio, where we decided to discontinue a program central to the company’s founding and refocus around a single remaining asset. It wasn’t a decision driven purely by financial models and it tested our leadership system, demanding that we move quickly, communicate clearly, and keep the team aligned even as the outcome remained uncertain. What carried us wasn’t certainty. It was coherence: a shared sense of purpose that allowed the organization to move together through ambiguity.
That moment echoed my experience as a critical care anesthesiologist. The operating room—especially in urgent or complex cases, is a space of partial data, fast-moving variables, and razor-thin margins. In those moments, waiting for perfect clarity can be as dangerous as acting too soon. The best clinical teams I worked with weren’t immune to uncertainty; they were fluent in it. They knew how to move with incomplete information because they shared a goal, a language, and a structure that enabled action under pressure.
Biotech is beginning to require that same fluency. In a landscape where the map keeps changing, the role of leadership isn’t to eliminate ambiguity. It’s to create the conditions in which teams can move through it, with trust, judgment, and intent.
Conclusion: Toward a New Organizational Stack
What can a SEAL Team commander, a battlefield general, and a Delta Force strategist teach biotech? At first glance, the connection might seem remote. But the conditions they navigated: dispersed teams, incomplete information, compressed timelines, are now part of biotech’s daily operating reality. These are systems-level challenges that demand structural solutions. The models above aren’t doctrine; they’re tools. They matter because biotech’s organizational demands are evolving alongside its scientific ones. We can’t manage this shift with hierarchy alone or by adding layers to the org chart. Something deeper is needed.
That realization struck me during the keynote. But the themes weren’t new. They brought me back to 2003, to the night of the Station nightclub fire in Rhode Island. Nearly a dozen burn victims were transferred to Mass General, where I was working as an attending. There was no protocol. No playbook. Teams formed on the fly. Even there, resources were stretched thin for hours—sometimes days. The complexity was staggering. What held us together wasn’t just training or experience, though both mattered. It was a kind of leadership architecture long familiar in medicine: where the person with the clearest context led, even if not the most senior; where autonomy stayed anchored to mission; where purposeful action persisted, even in uncertainty.
These principles will be familiar to anyone who’s led under pressure. That’s what makes them relevant, not that they’re clever or new, but because they describe something real. Biotech is changing. So must the way we lead, how we delegate, align, and decide. Not just for resilience, but out of fidelity to the work itself. Most of us believe we are contributing, in some way, to the future of human health. My argument here is simple: that goal deserves an operating model that can keep up.
