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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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