Antimicrobial resistance (AMR) demands collective action to reduce and mitigate its threats. The Quadripartite collaboration of the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP) and World Organization for Animal Health (WOAH) has led development and implementation of National Action Plans (NAPs) that describe approaches each country will take to tackle AMR. All antimicrobial users and sectors should be included, and the Quadripartite encourages a One Health approach. Aquaculture has received mixed coverage in NAPs: Here, we argue why aquaculture requires special consideration. Aquaculture is a diverse, global collection of industries and activities, with heterogeneity in systems and species greatly exceeding terrestrial food-animal production, with products traded internationally in huge volumes. Almost 6 % of global total antibiotic usage is estimated to be applied in aquaculture, with per-biomass quantities in some species exceeding usage in human and terrestrial food-animals. The watery nature of aquaculture interconnects it with other One Health compartments: humans, other animals and the wider environment. Rapid industry growth challenges relatively detached stakeholders such as regulators and NAP creators to remain abreast of changing practices, whilst support capabilities and capacity, e.g., health services, typically lag behind growing needs. To integrate aquaculture effectively into next-generation NAPs, ensuring policies cover the One Health spectrum, NAP creators need to recognise the diversity of aquaculture and initiate engagement across associated value chains, especially health service providers. Disentangling the industry can assist formulation of realistic policies for heterogenous contexts and identify pathways to implementation. Resource allocation must be appropriate and include relevant government departments, whilst improved ways to track and monitor AMR, including those international activities that impact AMR domestically, through suitable data collection are key to monitoring and evaluating policies. Better NAPs are crucial to addressing AMR and this coordinated global approach provides our best opportunity for success.