Gene and cell therapies have matured from speculative biology into an approved category of medicine. Twenty-plus ATMPs are now authorised in Europe; dozens more sit in pivotal trials; the science, contested only a decade ago, is settled. The barrier is no longer whether these therapies work. The barrier is the system through which they reach the patients for whom they were designed. Today, that system is expensive, geographically locked to a small number of academic centres, and slow in ways that compound — each handoff between a diagnostic lab, a manufacturing site, a clinical centre, and a payer adds weeks, errors, and cost. For a disease that progresses on the timescale of months, this is not a logistics problem. It is a definition of who gets treated.