Emma J. Rosi, Jerker B. Fick, Barbara Han

Novel viral pathogens are causing diseases to emerge in humans, a challenge to which society has responded with technological innovations such as antiviral therapies. Antivirals can be rapidly deployed to mitigate severe disease, and with vaccines, save human lives and provide a long-term safety net against new viral diseases. Yet with these advances come unforeseen consequences when antivirals are inevitably released to the environment. Using SARS-CoV-2 as a case study, we identify global patterns of overlap between bats and elevated pharmaceutical concentrations in surface waters. We model how freshwater contamination by antivirals could result in exposure to insectivorous bats via consumption of emergent insects with aquatic larvae, ultimately risking the evolution of antiviral-resistant viruses in bats. The consequences of widespread antiviral usage for both human and ecosystem health underscore urgent frontiers in both scientific research and sustainable development.