The Business Ethics for APEC SMEs Initiative is the world’s largest public-private partnership to strengthen ethical business conduct and create a level playing field in the biopharmaceutical and medical technology sectors. The Initiative also serves as the largest collective action initiative to promote ethics and business integrity across health systems in the APEC region. The 10th annual APEC Business Ethics for SMEs Forum was held in Washington, DC in September 2023 during the United States’ APEC host year. On the occasion of the 10th anniversary of the annual Forum, this publication reviews key milestones and outcomes of the Business Ethics for APEC SMEs Initiative and charts a path for its future.