JONATHAN M. METSCH, Dr.P.H. – Tracking Emerging Public Health Challenges – May 31, 2026 – World Cup
“The World Cup converges every major travel health risk into a single five-week window: The three host countries are experiencing active measles outbreaks. The top fan countries carry the highest vector-borne disease burden in the world.
The vaccine wall is eroding across the tournament map: Outbreaks are ongoing in host and participating countries, and herd immunity can no longer be assumed in most locations.
Evolving pathogens are changing the risk calculus: Norovirus GII.17 exploits the exact environment — resorts, airports, mass gatherings — that define summer travel and the World Cup. Malaria treatment failures have been documented in returning travelers from Africa. Multidrug-resistant foodborne pathogens are circulating at major travel destinations. Standard protocols are under pressure.
Travel networks amplify new pathogen variants: The risks facing travelers in 2026 are not the ones most organizations planned for. Mosquitoes now carry dengue in places they didn’t five years ago. A norovirus genotype with an edge over population immunity is circulating globally. Malaria drugs are failing. And the vaccines that were supposed to provide community protection are proving insufficient as coverage erodes.
Travel patterns vary by origin, destination, and season. Generic assessments miss the dynamic, local picture. The World Cup compresses all of it into one summer, across three countries.” (1)
“Several shared healthcare pressures are expected across all three host countries during the tournament period:
Temporary surges in demand during match days, particularly for minor trauma, heat illness, dehydration, and alcohol-related presentations.
Increased utilization of emergency departments for non-critical conditions by international visitors unfamiliar with local healthcare pathways.
Pressure on ambulance and pre-hospital emergency services in high-density event zones and nightlife districts.
Increased demand for multilingual healthcare support and medical interpretation services.” (2)
(Massachusetts) DPH’s Office of Preparedness and Emergency Management (OPEM) is leading preparation efforts for the department. OPEM’s long-tested experience successfully coordinating public health operations for major gatherings, like the Boston Marathon, will inform all activities. This involves:
Comprehensive, multi-agency planning
Real-time surveillance and situational awareness
Coordinated emergency preparedness and response actions
Healthcare system readiness
Risk communication
Close collaboration with local, state, federal, and private partners
DPH will be ready to handle a wide range of issues. This includes everything from minor illness to disease outbreaks to a mass casualty incident. Particular attention will be focused on:
Infectious disease outbreaks, including infectious disease not commonly experienced in the United States
Foodborne illness
Mass casualty events and other events that may increase healthcare demand
Weather-related hazards, including extreme heat, severe storms, and other environmental health concerns
This means enhanced disease surveillance and monitoring, environmental health oversight, extreme heat preparation, food safety monitoring, and ongoing coordination and communication with healthcare providers and public safety officials across the region.” (3)
What RIDOH Is Doing to Prepare
RIDOH is working to ensure Rhode Island’s public health and medical infrastructure can accommodate the needs of visitors to the area, to ensure Rhode Island is prepared to respond to any potential emergencies with public health and medical impacts, and to relevent threats to Rhode Island’s food, water, and environment. These steps include but are not limited to:
Engaging staff, state agency partners, healthcare facilities and systems, emergency medical services, and community members in training and exercises that focus on capabilities to ensure readiness for this summer’s events;
Reviewing emergency response plans for all hazards, from infectious disease outbreaks to mass casualty events to bioterrorism attacks;
Expanding monitoring trends in visits to healthcare settings for increases in infectious diseases, drug overdoses, injuries, heat-related illness, and other health outcomes;
Expanding food safety trainings and resources and increasing food inspection and outreach;
Enhancing response plans and expanding testing capacity for infections not typically seen in this region;
Continuing wastewater monitoring for respiratory diseases like flu, RSV, COVID-19, avian influenza, and measles; and
Engaging with partners across the state to ensure relevant and timely communications.
The FIFA World Cup will bring unprecedented crowds, international visibility, and a complex threat environment
to Washington State. With hundreds of thousands of visitors, packed stadiums, fan zones, and transit hubs operating at peak capacity, the potential for medical emergencies—both accidental and intentional—rises sharply. Ensuring strong medical readiness is essential for several reasons:
• Mass-gathering risks increase sharply. Large crowds heighten the likelihood of trauma, cardiac events, heat-related illness, substance-related emergencies, and crowd-surge injuries.
• Terrorism and targeted violence threats are elevated. Global sporting events are historically attractive targets for bombings, shootings, and intentional biological or chemical exposure. Recent planning discussions with the State Emergency Management Division have reinforced the plausibility of these scenarios.
• Hospitals are already at peak occupancy in June and July. The World Cup overlaps with the highest census months, meaning the healthcare system must be prepared to absorb additional surge without compromising care.
• Rapid coordination across the region becomes essential. Effective patient placement, communication, and tracking across your local community and region as well as throughout Washington State are critical to managing multi-site incidents and preventing system overload.
• First responders and frontline staff need strong support. High-risk environments increase the likelihood of responder injury or exposure, requiring robust medical capability to keep emergency operations functioning.
• Critical infrastructure must remain resilient. Lumen Field, fan zones, practice sites, and transit hubs all depend on reliable medical coverage to operate safely and recover quickly from disruptions. Medical response readiness is foundational to the safe and successful execution of the FIFA World Cup around the state. It protects residents, visitors, and first responders; strengthens the resilience of critical infrastructure; and ensures the region can respond effectively to both expected and unexpected threats during one of the largest events the state has ever hosted.
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HOSPITAL PREPAREDNESS – Please use the following checklists recommendations to prepare your organization for FIFA World Cup 2026. (4)
This year’s World Cup is testing the public health playbook, https://www.cnn.com/2026/05/27/health/world-cup-public-health
US, Mexico, Canada announce Ebola-related travel measures ahead of World Cup, https://www.reuters.com/business/healthcare-pharmaceuticals/us-mexico-canada-announce-ebola-related-travel-measures-ahead-world-cup-2026-05-28/
Ebola at the World Cup? Here’s what we should actually worry about, By Krutika Kuppalli, https://www.statnews.com/2026/05/28/ebola-world-cup-travel-public-health-measles/
1.Your Risk Map Is Outdated: What the 2026 World Cup Reveals About the New Travel Health Landscape, https://bluedot.global/your-risk-map-is-outdated-what-the-2026-world-cup-reveals-about-the-new-travel-health-landscape/
2.2026 World Cup to Elevate Heat, Respiratory Disease, and Environmental Health Risks Across Host Nations, by Robyn Mazriel, https://www.crisis24.com/articles/2026-world-cup-to-elevate-heat-respiratory-disease-and-environmental-health-risks-across-host-nations
3.How DPH is preparing for the World Cup, https://www.mass.gov/info-details/how-dph-is-preparing-for-the-world-cup
4.Hospital Preparedness Checklist – FIFA World Cup, https://nwhrn.org/wp-content/uploads/2026/03/Hospital-Preparedness-Checklist-FIFA-Worldcup_2026-03.pdf
5.Protecting Public Health in Rhode Island During the FIFA World Cup 2026™ and the Rhode Island Summer of Soccer™, https://health.ri.gov/soccer2026
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai