JONATHAN M. METSCH, Dr.P.H. –Tracking Emerging Public Health Challenges – June 4, 2026 – World Cup
The “syn” part of syndemic refers to the way multiple outbreaks or epidemics, which are not necessarily all infectious diseases, work together in a synergistic way that amplifies the outcome, according to Dr. Tyler Evans.
Evans is an adult infectious disease and addiction medicine specialist, founder and CEO of Wellness Equity Alliance and an associate professor at the University of Southern California Department of Population and Public Health Sciences. He’s also someone who has spent time, boots on the ground in African nations treating people, including many with Ebola. He wrote the book “Pandemics, Poverty and Politics,” published last year by Johns Hopkins University Press.
“When you’re looking at an infrastructure system that is so impacted by all these social drivers, particularly poverty, war, etc., and then you throw in all these sort of chronic infections like AIDS, malaria, measles and tuberculosis, and then you throw in Ebola and we’ve been dealing with hantavirus, then basically the outcome is amplified because they’re sort of interacting with each other,” he said.” (1)
“As World Cup fever rises in the Americas, countries are urged to strengthen measles surveillance and vaccination amid ongoing outbreaks across the region.
The combination of rising measles transmission and increased international travel creates conditions that could accelerate the spread of the disease during large-scale events, the UN-backed Pan American Health Organization (PAHO) warned in an alert.
It urged authorities to step up surveillance, identify the highest-risk areas and ensure that travellers have access to information and vaccination services ahead of the World Cup and other mass gatherings.
People everywhere are gearing up for the tournament, which runs from 11 June to 19 July. For the first time ever, the world’s biggest sporting event is being held in three countries: Canada, Mexico and the United States.
The World Cup takes place as measles is on the rise globally, and across the Americas. This year, more than 184,000 cases were reported in 155 countries by 13 May, and nearly half were confirmed.
The majority, 29 per cent, were in the Southeast Asia region, followed by the Eastern Mediterranean, 21 per cent, while Africa and the Americas each accounted for 19 per cent of the global toll.
Across the Americas, 20,521 measles cases and 25 deaths were confirmed in 16 countries and one territory by mid-May, representing a fourfold increase over the 5,123 cases during the same period in 2025 and already surpassing the total caseload recorded that year.
Since January, Mexico has confirmed 10,920 cases and 13 deaths, while Guatemala has reported 6,209 cases and 12 deaths. Canada has reported 1,018 cases and the US 1,952.
Other countries–among them Bolivia, Belize, Costa Rica, El Salvador, Honduras, Panama and Uruguay—have also reported cases linked to outbreaks or importations.
Most reported measles cases have occurred among people who were unvaccinated or whose vaccination status was unknown.” (2)
“Despite those worries, the risk of widespread Ebola transmission during the tournament is low, infectious disease experts told CNBC. Public health departments, hospitals and other partners are also well equipped to respond to a range of potential threats — even after sweeping cuts to critical federal agencies and the U.S. exiting from the WHO under the Trump administration.
“Ebola and hantavirus, I worry about a lot less,” Dr. Shruti Gohil, the associate medical director for University of California, Irvine Health Epidemiology and Infection Prevention, said in an interview. “The overall likelihood of risk is not nonzero, but it’s low, very low, because it is not easy to transmit person to person.”
Instead, experts say more contagious threats could pose greater challenges during the tournament and other large events this summer, particularly because international visitors could move through multiple venues and cities in a matter of days.
Those threats include measles — one of the world’s most contagious diseases — as well as respiratory viruses such as Covid-19 and influenza. The concern comes after the U.S. recorded its highest number of measles cases in decades last year, driven in part by growing vaccine hesitancy and declining immunization rates.
Some experts also pointed to arboviruses spread by infected insects, such as dengue, while others highlighted heat-related and foodborne illnesses as notable risks beyond infectious diseases.
Preparing for the World Cup has involved scaling up existing programs, such as wastewater monitoring, and adding new tools to track infectious disease threats. Those systems will face their first major test when the tournament kicks off on June 11, but public health officials say they are ready to take on the challenge.” (3)
“With millions of visitors expected for the World Cup, which begins June 11, the health origination urged countries to strengthen epidemiological surveillance in high-risk areas, including border regions, airports, ports and venues hosting major international events.
The 2026 FIFA World Cup will feature 48 national teams, a record for the tournament. It will be held in Mexico, the United States and Canada from June 11 through July 19. FIFA estimates that more than 6 million people will attend some of the tournament’s 104 matches, which will be played in 11 U.S. cities, three cities in Mexico and two cities in Canada.
Regarding the World Cup and other mass gatherings, the health organization recommended that travelers 6 months and older who cannot provide proof of two doses of measles-containing vaccine or evidence of immunity receive a measles-rubella vaccination, preferably at least two weeks before traveling to areas with documented transmission.
The group also recommended expanding active case detection efforts, maintaining rapid response teams and strengthening international contact-tracing coordination.
While proof of measles vaccination is not required for entry under the International Health Regulations, the organization stressed that vaccination remains the most effective measure to prevent transmission and protect public health.” (4)
“While U.S. health officials insist a major outbreak of Ebola in the U.S. is highly unlikely, the matches and large crowds they will bring is leading to a fresh wave of worry about the spread of disease.
“It’s pretty reasonable to assume we’re not well prepared to handle anything like this,” Glen Nowak, a former Centers for Disease Control and Prevention (CDC) official and infectious disease expert, told The Hill. “There’s been a lot of things that have happened in public health that have weakened the system. There are more divides in red states versus blue states in terms of their approach to public health these days, so we’re not prepared if there were some sort of large-scale outbreak.””
“Experts say potential threats remain, though they may take the form of more common illnesses than Ebola.
“Infectious disease threats during the World Cup will almost certainly look much more familiar than frightening headlines suggest,” Krutika Kuppalli, an infectious disease physician in Dallas who has worked with the World Health Organization, wrote in an op-ed for Stat News. “The greatest risks are likely to come from pathogens we already know well and, in many cases, already have tools to prevent.” “ (5)
“But keeping World Cup fans healthy will be anything but routine. Their worst fear? A public health emergency like a measles outbreak. If local health department leaders didn’t have each other’s cell phone numbers before, they do now. “An event like the World Cup is different fundamentally because of the scale,” said Ray Dlugolecki, assistant director of the Jackson County Public Health Department. “We will have visitors from across the world. We’ll have large crowds, summer heat, we’ll have people moving throughout the entire metro, not just in and around the stadium.
“So from a public health perspective, all of those factors, those considerations, create a mix of issues we need to be monitoring all at the same time. “And that includes common contagious illnesses that we see here locally, it could be common contagious illnesses that are seen throughout the world that we don’t see much of here. “And there’s heat-related illness, there’s food safety concerns. And then we always, in public health, have to be aware of anything unusual that might require a quick response. So all of those factors together create this complexity because of the scale of this event.”” (6)
1.Africa’s in a ‘syndemic.’ Here’s why U.S., others should pay attention, By Lois M. Collins, https://www.deseret.com/lifestyle/2026/06/04/ebola-hantavirus-spread-world-cup-global-surveillance-down-syndemic/
2.Regional health agency issues measles alert for World Cup, https://news.un.org/en/story/2026/06/1167642
3.As the largest World Cup ever kicks off, health officials are focused on more than Ebola, by Annika Kim Constantino, https://www.cnbc.com/2026/06/04/world-cup-2026-health-officials-focused-on-ebola-measles.html
4.Measles resurgence in Americas raises concerns before World Cup, By Macarena Hermosilla, https://www.upi.com/Top_News/World-News/2026/06/03/latam-measles-alert-world-cup-travel/6701780501094/
5.Ebola triggers fears over public health ahead of World Cup travel surge, by Dominick Mastrangelo, https://thehill.com/policy/keeping-score/5901607-ebola-concerns-world-cup/
6.Heat, measles, STIs, food poisoning: KC health officials aim to keep World Cup safe By Lisa https://thehill.com/policy/keeping-score/5901607-ebola-concerns-world-cup/
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai