Shellfish production forms a large proportion of marine aquaculture production in Northern Ireland (NI). Diseases represent a serious threat to the maintenance and growth of shellfish cultivation with severe consequences to production output and profitability. In Northern Ireland, production generally benefits from a good health status with the absence of notifiable diseases, except for localised cases of Bonamia ostreae, Marteilia refringens and ostreid herpes virus. In this paper, we qualitatively explore that the prevalence, risk, impact, mitigation and experience shellfish farmers in this region have in relation to disease. Sixteen semi-structured interviews were conducted with stakeholders within the sector. The interviews were transcribed verbatim, and Nvivo 12 was used to facilitate an inductive thematic analysis. Our results highlighted that the industry has varying attitudes and experiences with disease. At present-day temperatures, disease is not an issue and this provides vast market opportunities for the region. However, disease outbreaks have led to detrimental consequences to financial income, production output and reputation in the past, whilst control and mitigation remain reactive. It is imperative proactive disease prevention and control that are employed and enforced to sustain NI’s reputation as a healthy shellfish region, particularly under increasing global temperatures and intensified production systems. A cultural shift to disease appreciation, risk analysis and surveillance through research, education, training and collaboration is essential. This study highlights the importance of providing a bottom-up communication platform with the stakeholders directly involved in shellfish culture and management, the value of cross sector engagement and the need to improve knowledge transfer between science the sector.