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Malnutrition is widespread and affects about one-third of humanity. Increasing production and consumption of vegetables is an obvious pathway to improve dietary diversity, nutrition and health. This chapter analyses how climate change is affecting vegetable production, with a special focus on the spread of insect pests and diseases. A thorough literature review was undertaken to assess current global vegetable production, the factors that affect the spread of diseases and insect pests, the implications caused by climate change, and how some of these constraints can be overcome. This study found that climate change combined with globalization, increased human mobility, and pathogen and vector evolution has increased the spread of invasive plant pathogens and other species with high fertility and dispersal. The ability to transfer genes from wild relatives into cultivated elite varieties accelerates the development of novel vegetable varieties. World Vegetable Center breeders have embarked on breeding for multiple disease resistance against a few important pathogens of global relevance and with large evolutionary potential, such as chili anthracnose and tomato bacterial wilt. The practical implications of this are that agronomic practices that enhance microbial diversity may suppress emerging plant pathogens through biological control. Grafting can effectively control soil-borne diseases and overcome abiotic stress. Biopesticides and natural enemies either alone or in combination can play a significant role in sustainable pathogen and insect pest management in vegetable production system. This chapter highlights the importance of integrated disease and pest management and the use of diverse production systems for enhanced resilience and sustainability of highly vulnerable, uniform cropping systems.