Laying the groundwork for an inter-ministerial One Health response to antimicrobial resistance in South Korea.

Background: The five-year project to address the threat of AMR, One Health Multi-Ministerial Project on AMR, was implemented in 2019 in South Korea with coordinating action across human, animal, environmental, and food sectors. To describe the design, implementation, and outcomes of the initiative, assess its contribution to AMR preparedness, and identify policy implications for sustaining progress. Methods: A structured evaluation framework was applied integrating quantitative and qualitative indicators across four domains: (i) infrastructure building, (ii) multisectoral surveillance, (iii) containment of AMR spread, and (iv) outcome translation and dissemination. Results: Over five years, the overall performance rate reached 92.2 %, with completion rates of 96.7 % for infrastructure building, 86.7 % for multi-sector surveillance, 92.5 % for containment of AMR spread, and 92.9 % for outcome translation and dissemination. Standardized annual assessments, based on weighted indicators and capped scores, ensuring transparent evaluation. While most targets were achieved or exceeded, partial attainment in database registration, policy proposals, and innovation outputs highlights priorities for future development. These results demonstrate effective implementation of South Korean One Health AMR strategy. Major achievements included the establishment of standardized laboratories, the acquisition of 20,061 biological resources, the launch of a One Health AMR portal, and expanded surveillance across sectors. Conclusions: The initiative operationalized the core principles of One Health, i.e., integration, multisectoral collaboration, data sharing, sustainability, and policy integration, while addressing structural gaps in AMR preparedness. Although challenges remain in stewardship, surveillance coverage, and long-term governance, the project provides a durable foundation for the national strategy for future AMR in South Korea.