Aquaculture stands as the fastest-growing food fish sector, expected to satisfy global demand for aquatic products. However, its expansion has led to disease emergence, adversely affecting both production and biodiversity. In response, since the mid-1990s the World Organisation for Animal Health (WOAH) has developed initiatives, notably the Aquatic Animal Health Code and the Manual of Diagnostic Tests for Aquatic Animals, aimed at harmonising health standards for international trade in aquatic animals. With advances in aquaculture came the global spread of pathogens, resulting in significant disease outbreaks and economic losses. Efforts to curb these events led to the establishment of emergency programmes and conferences emphasising surveillance, preparedness and response, and fostering increased collaboration among stakeholders. As aquatic animals grow in importance for global nutrition and food security, the emergence of new pathogens poses a threat. Understanding disease mechanisms and main drivers becomes pivotal for disease prevention. Collaboration across sectors, including government, industry, science and stakeholders, is vital for implementation of effective biosecurity measures to mitigate disease risks. The Aquatic Animal Health Strategy, introduced by WOAH in 2021, reflects the recognition of the growing significance of aquatic animal health and its relevance in food security and outlines a strategic approach to management of aquatic animal health worldwide. Emphasising standards, capacity building, resilience and leadership, this Strategy aims to address critical challenges in aquatic animal health and welfare. Looking forward, the One Health approach will become imperative in confronting global health risks. In this holistic approach to ensuring sustainable aquaculture, it is important to recognise the great value of the people working in aquaculture and their contribution to global food security.