takeholders’ intentions in partnering in the healthcare space can range widely but often include sharing resources, collaborating to take new risks, achieving mutual benefit, and providing greater societal good. Such stakeholders include representatives from pharmaceutical companies, other health-related industries, regulatory bodies, academia, industry, patient groups, and HTAs. They see partnerships as necessary to overcome the complexity of problems facing the health sector and to sustain positive outcomes. However, several challenges get in the way of effective partnering:

• Fragile Trust: Insufficient attention to the ongoing need to nurture deeper trust. When trust is fragile or still growing, interactions may become more transactional than collaborative.
• Power Imbalances: Behaviors that seek to control can create or exacerbate power imbalances and block collaborative potential.
• Internal Misalignment: Differences (within or between a partner organization) about the importance of partnership can weaken stakeholder engagement and commitment.
• Diverse Expectations: Different, possibly divergent, expectations between partners can lead to tensions and slow down progress.

For the past several years, DIA has been working with the Partnership Brokers Association (PBA), exploring how collaboration works among DIA stakeholders and whether there is scope within this exploration to strengthen current partnering practices to benefit the public health sector and the patients it serves.

In 2024, Dr. Leda Stott (PBA Associate and partnership expert for the European Community of Practice on Partnership) gave a Keynote Address at DIA Europe on the theme Building more sustainable collaborations in the healthcare ecosystem. She described the key characteristics of multistakeholder engagements, or partnerships, in the following terms: “Sustainable partnerships are multidimensional relations that promote transformation by addressing complex challenges holistically and creatively.” There followed a series of focus group discussions, and this article shares and builds upon their outcomes.

Barriers to effective partnerships in the healthcare sector can be overcome. Discussants identified other barriers such as misconceptions and myths about/between stakeholders; regulatory complexities; trust issues; and language nuances where understanding of terms differs, or where terminology might be experienced as judgmental (this is discussed further below). Aligning on a shared aspiration and clear objectives from the outset, understanding all partners’ diverse perspectives, fostering transparency, building trust, and exploring funding dependencies were identified as crucial steps to overcome such barriers and ensure sustainable relations and results.

Case Study: DRIVE – A Model for overcoming collaborative barriers

DRIVE was a public/private partnership aimed at monitoring brand-specific influenza vaccine effectiveness in Europe. DRIVE brought together regulatory agencies, vaccine manufacturers, and public health institutions to generate high-quality evidence to inform decision-making. A key factor in its success was its strong governance framework built on transparency, clearly defined roles, mutual respect, and shared benefits.

However, several obstacles also emerged. For example, although DRIVE fostered open dialogue with the European Medicines Agency (EMA) to align expectations and ensure regulatory compliance, “Hurdles and Potential Solutions/Alternatives” (paragraph 4.2) of the published review of this project pointed out that some Public Health Institutes (PHIs) were skeptical and feared conflicts of interest in working with vaccine manufacturers. This skepticism was reinforced by the European Centre for Disease Prevention and Control (ECDC), which prioritized a public-only vaccine monitoring initiative that limited DRIVE’s reach. Despite such hurdles, DRIVE provided a successful model of collaboration, built on joint interests, shared decision making, joint funding, and transparent governance and reporting. This success paved the way for other initiatives such as COVIDRIVE (now id.DRIVE), a public-private partnership which facilitates the conduct of infectious disease studies on vaccines and related preventative measures, therapeutics, and diagnostics.

Open conversations are rare but highly prized. People working in the public health sector can feel shrouded in myths, misconceptions, and assumptions about what can and cannot be done, with too little opportunity to explore shared realities and to understand each other better. Discussants viewed DIA as an effective convener, able to create opportunities for dialogue and information exchange across all healthcare stakeholders. One participant suggested: “The level of ambition changes when the level of trust and openness grows, and ability to deal with diversity is built. Understanding the difference that we bring into the room is really important.”

The theme of open conversations also emerged in two abstracts submitted for DIA Europe 2025:

• The European Directorate for the Quality of Medicines & Healthcare (EDQM) of the Council of Europe sees open conversations as crucial in their stakeholder engagement strategy, to build commitment, mutual understanding, and clear public communications. This lies at the core of their effectiveness in protecting public health, founded on successful collaboration.
• An abstract from a multinational biopharmaceutical company stressed that open conversations and good communications were vital in building trust in the global drug development ecosystem, making progress through complex regulatory and policy challenges, driving innovation, and promoting public health.

These abstracts were combined to shape a roundtable session at DIA Europe 2025, Stakeholder Engagement with a Purpose: My Role and Behaviors in Building Trust and Driving Success, featuring representatives of this multinational biopharmaceutical company, the PBA, and the EDQM.

Language matters. Terms such as “adherence” and “compliance” can be understood (by patient advocates for example) as loaded with blame if requirements are not met or if things go differently than expected; their use can alienate some stakeholders or create friction with others. Focus group discussants highlighted the need for attention and discourse on language, citing progress in the language used with people with diabetes (where an initiative called “Language Matters Diabetes” calls for sensitivity and respect in the terminology used by health professionals).

Measuring “success” through different lenses

Traditional metrics of success such as financial returns on sustainability efforts were discussed alongside broader measures like societal impact and shared aspirations. Successful collaborations were seen as those aligning with both financial and aspirational goals: achieving solid returns on investment and on aspiration.

The lack of a long-term vision in any sector can block achievement of sustainable results and enduring relationships. This lack of vision is exacerbated by geopolitical changes and increased competition. Continuous collaboration and dialogue are essential to refining and remaining focused on sustainable partnership goals.

Patients have a central role in healthcare, but focus group discussants pointed out that patients are often marginalized in partnerships and that key information often does not reach them. Balancing financial interests with patient needs and fostering genuine engagement can almost always be improved. What does “mutual benefit” mean for patients when, as one participant put it: “Doctors are the market, not the patients”? Are patients the core market of healthcare or just a consumer?

One 2017 multistakeholder initiative to combat respiratory syncytial virus (RSV) included a strong patient-driven initiative to raise public awareness and understanding of the virus: the RESCEU and then PROMISE projects. This complemented the collaborative research conducted through these projects, as the voice of patients and public health bodies (including ECDC and WHO) helped to explain and sustain the societal relevance of the work.

Compliance with drug development and approval regulations can provide a template for regulatory conformity in sustainability efforts: For example, receiving regulatory approval for a new product is the regulatory goal of every drug development program; at the same time, there is a lot of global variance in how different regulators approve these products, not only between the US and EU, but sometimes even across different EU Member States. Lessons learned in managing different regulatory expectations and processes across stakeholders will provide much value in partnering with regulators in healthcare sustainability efforts.

These discussions not only highlighted the complexities and challenges experienced in collaborations, but they also emphasized the transformative potential of genuine partnerships. By honestly addressing barriers to partnering, redefining success, and prioritizing patient engagement, healthcare stakeholders can work towards a more sustainable and impactful future for the healthcare industry.

Leda Stott concluded her Keynote Address with this simple but profound reminder: “Interpersonal connections are at the heart of partnering. It’s the connections between people that will make or break a collaboration.”

Appendix: Stakeholders and Types of Partnerships in Clinical Research and Drug Development

To learn more about, and continue conversations on, this topic, plan to attend DIA Europe 2026.