Global food security and nutrition depend heavily on aquaculture, the continued growth of which is crucial as the world heads towards a human population of at least 9 billion by 2050, while harvests from wild capture will, at best, stabilise at current levels. Thus, a fundamental question is: how can we sustainably increase aquatic food production? It is clear that aquatic animal diseases present a substantial threat and, consequently, aquatic animal health management has a critical role in food security. An ecosystem approach to aquaculture will mitigate impacts on ecosystem services and biodiversity, and provide the necessary resilience to future disease threats, including those exacerbated by climate change. Due to the nature of aquatic production systems, this approach must encompass fisheries and other sectors that share the same resources. Improved aquatic animal health management must be a key component of aquaculture's future. At the national level, public-private partnerships are vital in achieving objectives of common benefit. Improved disease reporting and response is critical in the control of listed and emerging diseases and can only be achieved through government, industry and stakeholder collaboration. Great potential exists to improve biosecurity from the farm to national level, but this will only be achieved through collaboration. Industry cannot develop effective biosecurity without a clear government strategy and support, specifically legislation which provides an effective framework for safe trade. Governments have a key role in creating a regulatory environment that supports effective biosecurity and is attractive to investment; such as one that supports the development and regulatory approval of therapeutics. The improved control of transboundary diseases requires the wider and more consistent implementation of OIE standards, particularly on disease notification. This can only be achieved through improved collaboration between trading partners and by supporting low-and middle-income countries to strengthen their aquatic animal health services. There is incredible potential for aquaculture to continue its rapid growth and increase its contribution to global food security. However, sustainable growth of aquaculture is threatened by both known diseases, which we cannot effectively control, and new diseases, which may become pandemic. Recent pandemics have shown that global production systems are epidemiologically connected and, consequently, aquatic animal diseases present a shared global threat that demands global solidarity. The world now depends on a sustainable future for aquaculture and improved aquatic animal health management is critical to its continued and growing contribution to global food security.