Microplastic pollution in marine waters around the globe is increasing exponentially. This is the first comprehensive review which focuses on microplastics as a source and vector for metals, antibiotics, toxic chemicals, pathogenic bacteria (Vibrio cholerae), and Harmful Algal Bloom (HAB)-forming dinoflagellates across the continents through ballast water. Microplastics in ballast waters serve as ‘hotspots’ for the development and spread of multiple drug-resistant human pathogens through co-selection mechanisms. Microplastic inoculation at distant countries through ballast water may pose a serious threat to human health due to higher incidences of bacterial disease outbreaks and HABs. The 2017 ballast water management convention lacks a provision for on-board treatment of microplastic-contaminated ballast water. We conclude that there is a pressing need to include microplastics in the ballast water management convention as a hazardous material. Efficient on-board ballast water treatment strategies and effective limits for microplastics in ballast waters need to be developed.