Dr. Karreman has been involved with managing fish health for four decades. Her career has spanned a wide range of veterinary roles, from practicing veterinarian and consultant in the aquaculture sector to regulatory medicine in developing the National Aquatic Animal Health Program (NAAHP; Canada). She has also worked in pharmaceutical development and regulatory affairs, interfacing with major regulators such as the US FDA and European Medicines Agency. Successful and effective fish health management at the sector, provincial or federal level requires veterinary judgement and experience, a good understanding of the various parties involved, knowledge of the regulatory environment, good negotiating skills and lots of patience. The biggest challenges – including managing catastrophic fish health issues - have been to build a strong enough consensus to support effective fish health management over the long term. The talk will present lessons learned from real-life scenarios.