Disease is a major issue in animal production systems and society demands that the use of medicines and vaccines be reduced. This review describes the breeding approaches that could be used to improve disease resistance and focuses especially on their application to pigs. Disease reduction by genetic means has certain advantages through cumulative and permanent effects, and direct and indirect selection methods are available. Direct selection for disease incidence requires, besides a unique pig identification and disease registration system, challenge routines that are inconvenient in intensive pig production. Indirect selection for the expression of immune capacity may be an alternative but requires detailed knowledge of the different components of the immune system. There is ample opportunity for genetic improvement of the immune capacity because immune traits show substantial genetic variation between pigs. We therefore conclude that indirect selection via immune traits is very interesting, also for practical implementation, and that there is an urgent need for knowledge, within lines, about the genetic relationships between immune capacity traits and resistance to specific diseases or to disease incidence in general. Furthermore, knowledge about the relationship between immune system traits and production traits is needed as well as knowledge about the effect of selection on the epidemiology of disease at a farm/population level and on the host-pathogen interaction and coevolution.