Abstract: Casgevy (exagamglogene autotemcel; exa-cel), the inaugural CRISPR-Cas9 gene therapy for sickle cell disease (SCD), received authorization from the United States Food and Drug Administration in December 2023, with a list price of US$2.2 million per patient. Sub-Saharan Africa (SSA), which accounts for approximately 75–80% of the global annual SCD births, lacks a regulatory approval pathway, procurement plan, and cost-effectiveness evidence to support the adoption of the Casgevy. A similar disparity was observed in 1996 when combination antiretroviral therapy (ART) was approved in high-income countries at US$10,000–15,000 per patient-year, with no access to SSA. By 2004, however, generic ART became available in the region for US$140 per patient-year.