Infectious diseases remain a primary constraint to global aquaculture growth, causing an estimated loss of over 10% of cultured aquatic animals and exceeding 10 billion USD in annual revenue loss. This comprehensive review examines the major challenges and strategic priorities needed to establish robust biosecurity frameworks across the aquaculture value chain. Key areas addressed include the production and accessibility of specific pathogen-free (SPF) seed, emergency preparedness and rapid response systems, advanced and pond-side diagnostic tools, and proactive microbial management strategies (such as r/K selection and targeted probiotic applications). Furthermore, the review evaluates the risks associated with global trade, non-conventional pathogen transfer routes (e.g., ballast water and biofouling), antimicrobial resistance (AMR), and fish welfare. To move from reactive disease treatment to holistic risk management, the authors advocate for the adoption of the FAO's Progressive Management Pathway for Improving Aquaculture Biosecurity (PMP/AB), emphasizing public-private partnerships, risk-based surveillance, and enforceable national regulatory frameworks.