Similar to the short-lived direct listing wave, the idea of staying private indefinitely will likely only apply to a handful of elite, capital-rich companies like SpaceX. The vast majority of successful startups will still follow the traditional IPO path to provide liquidity and access public markets.

Despite a resurgent U.S. IPO market, Axiom Biosciences is choosing Hong Kong for its public debut. This is not a move of necessity but a deliberate strategy to access a different investor pool interested in cell and gene therapy and to gain proximity to the Asian biotech market, challenging NASDAQ's default status.

Biotech companies may not have the luxury of choosing their IPO timing. Venture capital investors often push for a public listing as soon as possible to secure their own returns, creating systemic pressure that can overlook a company's long-term strategic needs and readiness for public markets.

While staying private can offer strategic advantages, particularly for future M&A, the biotech industry lacks a mature private growth capital market. Companies needing hundreds of millions for late-stage trials have no choice but to go public, unlike their tech counterparts.

Contrary to popular belief, staying private isn't always easier. The administrative burden of managing secondary share sales and controlling who gets on the cap table is a significant headache for CEOs, making an IPO an attractive solution for simplicity and control.

While many private founders fear going public, David George of a16z claims he's never met a public CEO who regrets it. Key benefits include easier and often cheaper access to capital compared to private markets, increased transparency, and the discipline it instills. The narrative of public market misery is overblown for most successful companies.

GenFit operates in a rare position for a biotech company by fully funding its three Phase 2 programs through royalty streams from a partnership with Ipsen and revenue from its commercialized MASH diagnostic. This model avoids shareholder dilution and reduces financial risk, providing significant operational stability.

NervGen's new CEO identified that being on the Toronto Stock Exchange kept the company in "anonymity." A key strategic move was uplisting to NASDAQ to gain visibility with U.S. analysts and institutional investors, recognizing that being on the right exchange is a critical marketing and fundraising tool.

Astute biotech leaders leverage the tension between public financing and strategic pharma partnerships. When public markets are down, pursue pharma deals as a better source of capital. Conversely, use the threat of a public offering to negotiate more favorable terms in pharma deals, treating them as interchangeable capital sources.