ABSTRACT Norwegian salmon aquaculture production has grown rapidly since the 1970s. Accompanying the growing production have been a number of disease challenges of which at least two of the outbreaks threatened the industry's existence. The challenges caused by disease may appear to become more serious as the number of diseases being diagnosed and measures taken by the companies and regulators to manage disease increase. We will review the development of the industry and how diseases have impacted economic viability, the impact of the most important diseases and their control measures as well as the development of the governance and regulatory system in relation to disease. Despite the many disease challenges faced by the industry, we will argue that it has never been in a better position to address these issues and the disease cost per kilo of fish has most likely never been lower. When the industry originated in the 1970s, the knowledge with respect to disease in relation to salmon, such as how to diagnose, prevent or control them, was highly limited. The growth of the industry created a corresponding demand for veterinary knowledge and services, and these have been rapidly growing alongside the industry. This veterinary capacity facilitates the identification of new diseases and the development of novel control measures created with increasing efficiency. However, challenges with diseases will persist, as in all biological production processes, as it is normally not economically optimal to eradicate any disease if this is possible at all.