This is part 2 of a two-part article. The first part was published yesterday, 6/11/26.
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By Meghan Holohan at CIDRAP, 6-12-26
The behind-the-scenes work of protecting World Cup fans from infectious diseases
The 2026 FIFA World Cup, which began yesterday and runs till
July 19, is the largest soccer tournament held in its almost 100-year
history. More than 100 matches will take place in 16 cities in the
United States, Canada, and Mexico with 48 national teams—16 teams more
than in the 2022 World Cup.
Planning the public
health response for an event of this scale is intensive and involves a
lot of coordination, Rebecca Katz PhD, MPH, professor and director of
the Center for Global Health Science and Security at Georgetown
University, told CIDRAP News. Seeing it in action will show how well
some US public health measures work.
“It’s also a
test of some of the surveillance tools that we rolled out during the
pandemic but we can use at scale during the World Cup,” she said. “I’m
thinking specifically around things like wastewater surveillance… It’s a
way to see just how powerful that surveillance tool is.”
Public
health professionals in Doha, Qatar, used wastewater surveillance
during the 2022 World Cup to track infectious diseases, which allowed
them to pinpoint the location of COVID-19 and enteroviruses and
intervene early, according to a 2024 study published in Heliyon.
Katz
is heading the Health Security Operations Center at Georgetown, a
partnership with MedStar Health. The center will analyze wastewater
surveillance data as part of its overall monitoring and communication
efforts during the games, issuing a daily situation report.
“The
idea behind this is to be an intelligence fusion center for disease
surveillance information and to be able to share that information
directly back out with local, state, and federal health authorities,”
she said.
The hope is that the center will bolster local efforts taking place in host cities.
“The
challenge we have in the United States is that not all jurisdictions
are resourced equally,” Katz said. Some regions “don’t have the
resources to fully be prepared or ready for the response and that’s
where we’re trying to think very creatively around the ways that
non-government entities can be force multipliers.”
Consultation hotlines, more food-safety inspections
Some
public health departments are taking innovative approaches during the
games. In Texas, clinicians can call the World Cup Infectious Diseases
Consultation Hotline if they’re worried that their patient has an
infectious disease. A nurse will answer the call to determine if the
caller needs to speak to a doctor.
“They’ll have an
ID [infectious disease] physician who’s on call talk to the provider to
help guide them through things they should be thinking about—whether or
not the patient needs to be escalated to higher level care,” said
Krutika Kuppalli, MD, an associate professor of infectious diseases in
the School of Public Health at UT Southwestern. “It’s really another
layer of support for clinicians who may be seeing patients who have
things that they may not be familiar with.”
The hotline will also allow public health officials to more quickly detect and contain infectious diseases.
“Preparedness
is something that’s always going on,” said Kuppalli, co-director of the
Texas hotline. “The point of preparedness is making sure that we can
quickly identify patients who may have particular diseases, make sure
they get the appropriate care and that we implement the appropriate
infection prevention control measures.”
For James
Garrow, MPH, Philadelphia deputy health commissioner, there’s been a lot
of coordination between the city, county, and surrounding communities.
“All
of those people are coming to the Philadelphia region,” he said.
“They’re going to be sightseeing. They’re going to go to places with
lots of other people, and the potential for additional exposures just
goes up.”
Events also will take place in surrounding counties, where fans will also stay.
“Being
able to have us all on the same page and react in lockstep together, as
we should when we need to respond to something,” Garrow said. “That’s
where a lot of the planning has gone into.”
In addition to coordinating with nearby communities, the
Philadelphia health department is also increasing its food-safety
inspections, especially of food trucks. The department also launched
Know Before You Go, a fan resource guide about how to stay safe from
heat and poor air quality and where to find medical treatment. It has
also revved up its sexual health campaign, Philly Keep on Loving.
It’s not lost on Garrow that the World Cup starts during Pride Month.
“Staff
are working with a lot of the bars and restaurants in Philadelphia to
make sure those resources for people to be able to get access to testing
and things like post-exposure prophylaxis [prevention],” he said.
They’re “working to make condoms as available as possible.”
Austin
Public Health in Texas will rely on air-quality monitoring as an
early-warning system and will examine hospital visits to detect any
worrisome increases in infectious disease cases.
Other
host cities' public health departments hope to score with fans by using
soccer-themed awareness campaigns. In Missouri, one Jackson County
Public Health Department effort focuses on Red Cards. Instead of calling
penalties, these Red Cards will encourage people to protect themselves
from STIs, other infectious diseases, and heat-related illness.
Middle-Brook
Regional Health Commission in New Jersey has bolstered its
surveillance and is encouraging fans to think about public health with
soccer-themed messages such as “keep germs on the bench.”
Potential strain on health systems
While cities and regions have prepared, there are concerns that the extra fans could overwhelm local hospitals.
“The
more people that are in your city, the more the pressure there’s going
to be on your healthcare facilities,” Amesh Adalja, MD, a senior scholar
at the Johns Hopkins Center for Health Security, said. “Not necessarily
because of infectious diseases that are spreading but just the fact
that there’s more people. There’s going to be more sprained ankles, more
belly pain, more heart attacks.”
Bernard Camins,
MD, an infectious disease doctor at the Icahn School of Medicine at
Mount Sinai, noted that the New York City Department of Health asked
hospital systems about their capacity and preparedness in the unlikely
event of bioterrorism during the World Cup. He believes Mount Sinai is
ready.
“It’s ingrained in our emergency department
in terms of diseases of high consequence, like measles, because we do
have potential exposures,” he said. “We’ve been preparing the entire
time for things like that.”
Federal cuts could complicate response
The
changes occurring at the US Department of Health and Human Services
have affected some planning for the World Cup. Because the United
States no longer participates
in the World Health Organization, international communication can be
challenging. “It does complicate... sharing disease surveillance
information across borders,” Katz said. “That is one very real issue
that’s being dealt with.”
Also, the federal government has invested less money into
public health and has fewer employees working on disease surveillance,
she noted. “The workforce that remains in public health departments at
the local, state, and federal level are all having to do more, often
with a little bit less,” Katz said. “The workforce is strained.”
Still,
she said staff at federal agencies such as the Centers for Disease
Control and Prevention (CDC) and the Defense Health Agency within the
Department of Defense are working on protecting public health. “There’s a
lot of things going on,” Katz said. But “they might not be quite as
robust.”
Philadelphia has consulted with federal
health agencies about its preparations. But Garrow said that public
health normally takes place at the local level.
“Federal
health agencies are not really on-the-ground responders,” he said.
“There are situations where like an Ebola case coming into any of the
FIFA cities, the federal government has the capacity to be able to swoop
in and help support that. But when we’re talking about a heat (illness)
or air quality or measles outbreak, the federal government has a lesser
role.”
If there were a major infectious disease outbreak, which
experts believe is unlikely, the CDC would investigate it. But dramatic
cuts in staffing could make that harder.
“The CDC has that expertise, but the CDC is a shell of what it
once was,” Adalja said. “The CDC is not as equipped as it could be to
handle any kind of role they might have in terms of mass
gathering–related outbreaks.”
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