in order to disseminate cures more broadly. Initially, such therapies will occur in high-income countries where advanced tertiary care centers provide cell manufacturing and medical support. Delivery of autologous HSCT therapies to the vast majority of individuals with SCD, who reside mainly in low-and middle-income countries, will be facilitated by reduced-toxicity in vivo approaches that selectively modify HSCs via intravenous or bone marrow injection of targeted delivery vehicles such as engineered nanoparticles or nonintegrating viral vectors (206)(207)(208). The NIH and the Gates Foundation are collaborating to develop gene-based cures for SCD on a global scale (209). We are confident that this endeavor will succeed, although it will require time and advancing technologies. In the meantime, autologous HSCT for SCD must be considered as an essential component of a larger, multifaceted effort that also includes widespread newborn screening, institution of preventative therapies such as immunization, prophylactic penicillin and hydroxyurea, better drugs, allogeneic HSCT, and optimized infrastructures for delivering both basic and advanced medical care.