The balance between medical innovation and access to the products of that innovation has always been challenging. It’s imperative to strike a balance as the cost of innovations such as cell and gene therapies climbs exponentially, more personalized medicine and prevention becomes possible, and the need to address inequities in access and outcomes rises to the global forefront. As science progresses towards cracking the codes of scourges such as cancer, Alzheimer’s, and infectious diseases, who bears the responsibility to ensure that people in need are able to benefit?