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Banana, <i>Musa</i> spp., is an important cash and food crop in the tropics and subtropics.  Panama disease (aka Fusarium wilt) is caused by a variable pathogen, <i>Fusarium oxysproum</i> f. sp. <i>cubense</i> (Foc).  The disease devastated the early ‘Gros Michel’-based export trades, and a “new” variant of Foc, tropical race 4 (TR4), affects Cavendish cultivars that were used to replace ‘Gros Michel’ and which are now responsible for 40% of all production. Perennial production of this crop and the polycyclic nature of this disease hinder the development of effective management strategies; in most situations, the only effective measures are the use of resistant cultivars and pathogen exclusion.  Until recent reports in Africa and Western Asia, TR4 was found only in the Far East.  Better information is needed on how the pathogen moved the distances that were implicated in these outbreaks.  Understanding how this occurred would be an important first step in slowing its spread, as managing this problem is much more difficult once an area is infested.  There is an urgent need to improve resistance to TR4 in commercially acceptable genotypes of banana.  The epidemiology and management of this disease are reviewed, as is the future of export and smallholder production.