The 2026 FIFA World Cup in the United States, Canada, and Mexico is set to be the largest mass gathering event in the country's history, with over five million tickets sold across 16 cities over 39 days. However, despite the event's significance, the federal government has allocated zero funding for public health, raising concerns about the country's preparedness for a potential outbreak. As an infectious disease physician and epidemiologist, I find this situation particularly troubling, given the historical precedents of mass gatherings leading to public health crises. The 2006 World Cup in Germany was hit by a norovirus outbreak, and the 2010 Vancouver Olympics saw two measles cases infecting 82 people. More recently, the Hajj in 2024 experienced extreme heat-related deaths and a meningococcal outbreak, while the Milan Cortina Winter Olympics in 2024 were disrupted by a norovirus outbreak.
The key to successful public health management at mass gatherings, as Dr. Ziad Memish, a former health security manager for the Hajj, emphasizes, is a single chain of command and real-time data flowing to a central command center every five minutes. However, the 2026 World Cup, spread across three countries, will have no such command structure in place. This lack of centralized coordination is a significant concern, as it makes it difficult to respond effectively to public health emergencies. The federal government's allocation of $625 million for law enforcement and security, but zero for public health, further exacerbates the problem.
The absence of federal funding for public health has led to a patchwork of efforts, with universities and the U.S. military stepping in to fill the gap. Georgetown University, for example, has built the Health Security Operations Center (HSOC), which pulls data from over 30 partners and produces daily situation reports for the Department of Homeland Security, the White House, and the Department of Health and Human Services. The Armed Forces Health Surveillance Division has also produced country-by-country importation risk maps for each U.S. host city, an analysis that the CDC never conducted or requested.
However, these efforts are not without their limitations. The HSOC, for instance, has no authority or capability to enforce its recommendations, and the military's surveillance does not coordinate with the CDC dashboard, Georgetown, or Brown. Moreover, the lack of federal coordination has led to a delay in the CDC's response to the Ebola outbreak in the Democratic Republic of the Congo (DRC), with clinicians receiving notifications five days after the outbreak was declared, compared to the same day for Africa CDC. This delay in response can have serious consequences, as seen in the DRC's cancellation of its pre-tournament camp in Kinshasa as a precaution.
The situation is further complicated by the concurrent outbreaks of Ebola in the DRC and hantavirus in South America, which are already straining global response capacity. The White House has issued a Title 42 order barring entry to anyone who has been in the DRC, Uganda, or South Sudan within the past 21 days, but the effects are already visible, with CDC representatives no longer participating in WHO calls and all U.S. secondees recalled. This loss of institutional knowledge can make it difficult to respond effectively to public health emergencies.
In conclusion, the 2026 FIFA World Cup presents a significant challenge for public health management, given the lack of federal coordination and funding. The historical precedents of mass gatherings leading to public health crises serve as a cautionary tale, and the current situation highlights the need for a more robust and coordinated response. As an infectious disease physician and epidemiologist, I am concerned about the potential for a deadly biological emergency, and I believe that the U.S. must take steps to improve its preparedness and coordination for the World Cup and beyond. The time for action is now, before it's too late.
