This year’s World Cup is testing the public health playbook

By Deidre McPhillips, CNN

(CNN) — The FIFA World Cup is now just a few weeks away, but Dr. Rebecca Katz has been worrying about the public health threats it poses for years.

“With any mass gathering event, there are certain disease conditions that people worry about,” said Katz, who leads Georgetown University’s Center for Global Health Science and Security. “There’s always something happening.”

There’s a well-established playbook for planning how to protect the public’s health during mass gatherings like the World Cup, experts say. But broader circumstances surrounding this year’s tournament, which is expected to bring millions of visitors to North America, are poised to test that playbook.

Right now, an Ebola outbreak in the Democratic Republic of Congo and Uganda is posing an acute global health concern. The World Health Organization has declared it to be a “public health emergency of international concern” — only the ninth such declaration since the criteria were established in 2005. And it’s happening while US and international health resources are also being directed toward responding to a rare hantavirus outbreak.

Although those rare and serious diseases are concerning, experts say that most public health preparation for the World Cup has been focused on familiar issues – but ramped up to match the scale of the event.

“We’re expecting the unexpected, but there’s this idea of ‘let’s make sure we’re also really expecting the expected,’ ” said Dr. Marcus Plescia, health director for the Fulton County (Georgia) Board of Health, which is home to the World Cup host city of Atlanta. “The common things are going to become even more common.”

Respiratory diseases are a particular concern during mass gatherings, and measles has quickly risen to the top of that list as all three World Cup host countries – the US, Mexico and Canada – face a recent surge in cases.

Other infectious diseases such as sexually transmitted infections also pose challenges, especially during celebratory times. And arboviruses — a group of viruses that spread to people through bites from infected insects, such as dengue from mosquitoes – were an early obsession for Katz and her World Cup concerns.

“We have the vectors for dengue, for chikungunya, for all of these disease challenges in the US, but what we haven’t had was enough people with those diseases to sustain the transmission,” she said. The World Cup, though, would bring in millions of people who could potentially make that chain of transmission more substantial, Katz said.

Local public health leaders have also noted concerns about high temperatures, air quality, drug overdoses, food safety and more.

Dr. Katelyn Jetelina, an epidemiologist and former senior adviser to the US Centers for Disease Control and Prevention, said heat-related illness is “probably the most reliable risk” beyond infectious diseases.

“Crowds plus sun plus summer temperatures plus physical exertion plus alcohol is a combination that sends people to emergency rooms every year,” she wrote in her public health newsletter, Your Local Epidemiologist.

Public health is always working to provide an “invisible shield” around communities, said Dr. Monika Roy, deputy health officer and director of the infectious disease and response branch with the County of Santa Clara (California) Public Health.

“We do this every day. It is the bread and butter, so we feel prepared, but having the resources to do so is very important,” she said at a briefing this month.

This year’s edition features the largest World Cup competition ever — with 48 participating teams, up from 32 — and it’s the first time games will be spread across three countries.

This unique scale makes the core elements of a public health response – clear communication, rapid surveillance and efficient coordination – even more vital.

“There’s a science to how to do this,” Katz said. But “this particular World Cup is a really complicated mass gathering,” she said. “This is coming at a time where resources are being reallocated and reprioritized in the public health space, and it’s also coming at a time when the United States has left the World Health Organization.”

Ebola risk is low, measles risk is higher

Plescia says he now considers measles – one of the world’s most contagious diseases – to be part of what he thinks of as “common core public health problems.”

2025 was a record year for measles in the US, and dozens of new cases each week put the country on track to nearly double that this year. Canada and Mexico have had large measles outbreaks, too.

“If there were a measles outbreak amongst a group of FIFA fans, it would be very challenging,” Plescia said, “because the fans are potentially going to move around with their team.”

The Georgia health department reported three cases of measles in a family from the Atlanta area just last week. But an exposure in Atlanta could also have consequences in another city, after fans have traveled on to see the next game.

This scenario highlights the importance of a multilayer public health response, experts say.

“If we just take measles, there’s approximately a five- to seven-day window between when you might see measles in the wastewater and when you might see the first case in an emergency department,” Katz said. “That amount of warning time has actually been used really effectively in the past – everything from alerting infection prevention control folks within hospitals, to even directly to individuals who then make decisions around vaccination.”

Public health tools that have been set up to manage infectious disease threats for the World Cup cast a wide net, experts say. Ebola is well within the scope of possible threats that officials are prepared to respond to, but the actual risk it poses is lower.

WHO officials have maintained since the start of the latest Ebola outbreak that the global risk level is low, even as the risk at the regional level rises.

The federal government has coordinated special airport protocols and screening for international travelers related to the Ebola outbreak: Passengers traveling to the US who have been in the DRC, Uganda or South Sudan in the previous 21 days must land in Atlanta, Houston or the Dulles airport outside Washington for health screenings.

Dr. Peter Hotez, ​dean of the Baylor College of Medicine National School of Tropical Medicine, said he would be willing to go to a World Cup game that the DRC team is playing in, with a lot of visiting fans in the stands — especially because Ebola doesn’t transmit until an infected person is noticeably symptomatic.

With an outbreak of this size, people shouldn’t be surprised to hear about new Ebola cases in some unexpected places, Hotez said, but there’s no particular risk of spread to Houston, which the DRC team plans to make its home base during the World Cup. The team will also be subject to the “same protocol for testing and isolation that American citizen returnees and legal permanent residents would be subject to,” a senior State Department official told CNN last week.

“The likelihood is not zero, but it’s not high,” Hotez said. “We need to be ready for it if that happens.”

Casting a wide surveillance net

But how will people know the risks where they are?

Earlier this month, Katz launched the Health Security Operations Center, a hub for monitoring potential infectious disease threats. As part of the National Center for Health Security and Resilience — a joint effort between Georgetown University and MedStar Health — and with the help of dozens of collaborators, the center will distribute daily situation reports to hundreds of organizations and individuals, including hospital emergency managers, state and local health officials, federal agencies and tournament organizers.

“We’re gathering a really broad array of data – wastewater data, traveler data, aggregated and de-identified (electronic health record) data — to build a generic surveillance net,” said Dr. Ethan Booker, an emergency physician and vice president of care innovation at the MedStar Institute for Innovation. “Part of the intention of gathering a broad net of data is to try to create some alertness for the possibility of an unknown.”

The CDC has developed its own World Cup data dashboard, which is in its final development state, an agency spokesperson told CNN In a statement. And the agency has tools that can assess the risk of outbreak potential and identify unusual patterns in surveillance data in near real-time, work that “helps jurisdictions evaluate risk and strengthen early warning capabilities in operational settings,” the statement said.

Local public health officials are also focused on broad, efficient surveillance.

Wastewater testing has been an increasingly popular public health tool since the Covid-19 pandemic because it can quickly help identify what may be circulating in a community in a passive way, without the need to test individual people for specific pathogens. Many public health leaders from World Cup host cities have cited wastewater surveillance as a key way they’re planning to monitor community health during the games.

“We’ve increased our sampling sites to cover all of Dallas County,” county health director Dr. Phil Huang said. “And we’re doing what’s called metagenomic testing, so we’re able to broadly detect anything that appears in the wastewater without pre-identifying specific pathogens we’re looking for.”

In Philadelphia, public health officials plan to have a special mobile lab that will allow for on-the-ground testing of various specimens, significantly cutting time and resources that are typically needed to send those samples to specialized labs in other parts of the state or country.

“We’ve been working to build out the unit for a few years,” city Health Commissioner Dr. Palak Raval-Nelson said. “Originally, it was not in anticipation of [this year’s] events; that’s how far back the funding goes. But now we’ve been geared up to make sure it’s up and ready.”

Cities are also working with local hospital systems to plan for a potential surge on health care utilization that could strain capacity and activating tbeir Emergency Operations Centers to keep the public safe and informed.

Federal coordination on health

The federal government awarded $625 million to host cities as part of the FIFA World Cup Grant Program through the Federal Emergency Management Agency. The CDC did not respond directly to CNN’s questions about whether host cities have received that funding yet or how the money could be spent specifically on protecting against health threats.

“CDC is actively engaged in World Cup preparedness as part of the federal coordination structure led by the White House FIFA World Cup 2026 Task Force,” an agency spokesperson said in a statement. “As part of HHS, CDC is regularly engaging with public health departments in host cities, other federal agencies, and partner organizations.”

The Pan American Health Organization, a ​regional office of the World Health Organization, is standing up its own operational center to coordinate around the World Cup. But US involvement is complicated since the country is no longer part of WHO.

Katz said that leaders from the Health Security Operations Center plan to participate in daily stand-up calls hosted by PAHO and share that information back out directly to state, local and federal partners.

In this and all of its activities, the center is operating “independently, but in support of” government work, Katz said.

Health threats keep evolving: In 2018, when FIFA named Canada, Mexico and the United States as hosts of the 2026 World Cup, coronaviruses were far from the general public’s awareness. The set of 16 host cities were announced in 2022, after the Biden administration reversed the first Trump administration’s attempt to withdraw from the World Health Organization. And when the match schedule was released in 2024, the record measles outbreak in Texas was still more than a year away.

Consistency is key to preparedness, experts said.

“We need a common-sense, consistent funding stream shared by federal, state and local policymakers to fully fund the public health system as a whole to prevent and respond to routine and emergencies that could occur,” Chrissie Juliano, executive director of the Big Cities Health Coalition, said at a briefing this month.

Nongovernment organizations can play a role, too.

“We would like to see a more persistently embedded capability to provide this surveillance more consistently,” said Booker from the MedStar Institute for Innovation. “Not just for the big event, but really improving the health security of America.”

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