More than 70% of the human population lives within five kilometres of a natural water feature. These aquatic ecosystems are heavily used for resource provision and recreation, and represent the interface between human populations and aquatic microbiomes, which can sometimes negatively impact human health. Diverse species of endemic aquatic microorganisms, including toxic microalgae and pathogenic bacteria, can be harmful to humans. Aquatic ecosystems are also subject to intrusions of allochthonous pathogenic microorganisms through pollution and runoff. Notably, environmental processes that amplify the abundance and impact of harmful aquatic microorganisms are occurring with increasing frequency owing to climate change. For instance, increases in water temperature stimulate outbreaks of pathogenic and toxic species, whereas more intense precipitation events escalate microbial contamination from stormwater discharge. In this Perspective we discuss the influence of aquatic microbiomes on the health and economies of human populations and examine how climate change is increasing these impacts.