JONATHAN M. METSCH -Dr.P.H. –Tracking Emerging Public Health Challenges – August 13, 2026 – World Cup
“The HHS Administration for Strategic Preparedness and Response (ASPR) leads the public health and medical response, ensuring that people’s health is protected during these events. And that role exists because of the authorities Congress established in the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA) and strengthened through its subsequent reauthorizations.
Behind every National Special Security Event (NSSE), there is a logistics and operational backbone that ensures the right personnel, equipment, credentialing, transportation, and communications systems are in place. In preparation for NSSEs, ASPR teams conduct operational assessments; identify resource requirements; coordinate with federal, state, and local partners; and ensure alignment across federal medical assets. During the event, ASPR responders provide federal public health and medical support onsite. All of these efforts are possible due to the authorities granted by Congress to enable ASPR to deploy trained and credential medical personnel.” (1)
“The largest FIFA World Cup 2026™ in history brought 48 national teams and millions of visitors to 16 host cities across the United States, Canada, and Mexico over 39 days. The matches drew the world’s attention. The work that kept them healthy did not — and that was the point.
Behind every match, the Centers for Disease Control and Prevention (CDC) ran a sustained public health effort to help protect fans, travelers, and the communities that hosted them, an effort years in the making and built on partnerships that reach into all 50 states.
CDC’s World Cup response was part of the federal coordination structure led by the White House FIFA World Cup Task Force, an effort formalized months earlier that intensified as the tournament approached. Throughout the event, CDC’s Office of Readiness and Response held regular calls with public health officials from all 11 U.S. host sites and federal partners, bringing together experts in epidemiology, laboratory science, and preparedness to share information in real time.
CDC worked closely with the Council of State and Territorial Epidemiologists (CSTE)* on Applied Epidemiology Recommendations for Mass Gatherings Preparedness and Response, giving partners and STLT epidemiologists practical recommendations for integrating surveillance, data systems, and staffing into World Cup™ planning.” (2)
“Past host nations faced significant challenges. During the 2014 World Cup in Brazil, only 34% of surveyed hospitals had received preparedness training, more than half lacked formal public agency communication channels, and just 27% could isolate patients during infectious surges.1 Coupled with ongoing public health funding cuts and increasing vaccine hesitancy, these gaps risk public health during large-scale events.
‘A proactive, multidisciplinary planning approach is therefore essential. Implementing the Incident Command System (ICS) about a month prior to match day ensures synchronized coordination across emergency medical services (EMS), hospitals, public health departments, security, and venue organizers. Best practices, as suggested by Smith and colleagues, include the formation of medical advisory groups comprising clinical leaders, public health officials, and operational stakeholders to guide contingency planning and emergency response.2
At the heart of preparedness lies scalable critical care through the Emergency Mass Critical Care (EMCC) framework. EMCC allows health systems to amplify ICU-level capabilities—including ventilators, vasopressors, IV fluids, antimicrobials, and sedation—in nontraditional care areas (eg, postanesthesia units or telemetry wards) for up to 10 days using expanded staffing positions.3,4 Emphasis must be made on the importance of embedding intensivists in disaster response planning and stressing their roles in staffing models, load-balancing, interagency coordination, and operational resilience.5’” (3)
“Mass gatherings substantially increase transmission of infectious diseases. 5 Physical proximity, the sharing of food, drinks, utensils and celebratory embraces (after goals, victories) are potential mechanisms of transmission. Infectious diseases can spread through various pathways, including respiratory droplets, aerosol particles, fecal-oral routes, direct contact (ie, touching and sexual transmission) and indirect contact with contaminated surfaces. This risk is augmented as mass gatherings that concentrate people with diverse health statuses, levels of vaccination, and recent travel from a wide range of countries that may have variable infectious disease endemicity not present in a specific host country—all resulting in an environment where susceptible individuals are exposed to a wide range of potential pathogens. 6,7 Thus, a competitive “mega sporting event”, such as the World Cup or the Olympics, requires healthcare personnel (HCP) and public health officials to support preparedness efforts and to have awareness of implications for players, coaches, event staff, officials, volunteers and spectators—both in and out of the stadium.
In a time of post COVID-19 pandemic global disruption, policy challenges and limited resources in public health preparedness and response, this review aims to support public health and healthcare facility preparedness for mass sporting events. Our commentary will briefly review infectious risks of previous World Cup and large sporting events; outlines our expert assessment of anticipated risks during World Cup 2026™; reviews the importance of hospital based and public health preparedness, and discusses opportunities for further collaboration both on and off the field.” (4)
“When Spain claimed their second World Cup title at MetLife Stadium in New Jersey on July 19, over 80,000 fans in the stadium and billions worldwide captured the moment. Across 39 days, 48 teams, and 104 matches spread across the United States, Canada, and Mexico, the 2026 FIFA World Cup drew what is likely the largest synchronized global audience in history.
On the same day, the World Health Organization’s data showed that the Bundibugyo Ebola outbreak in the Democratic Republic of the Congo had reached 2,344 confirmed cases and 930 deaths. Two days earlier, WHO Director-General Tedros Adhanom Ghebreyesus had issued a stark warning that this was the fastest-spreading Ebola outbreak on record. The 2018 North Kivu outbreak took more than ten months to surpass 2,000 confirmed cases, while this one took two. On June 24, France confirmed a case in a physician returning from the DRC, a sign that the outbreak’s reach was extending beyond Central Africa.
These two realities shared the same day without sharing the same conversation. The competition for global attention between sporting spectacle and public health crisis is a familiar struggle for global health practitioners, who have long sought to turn moments of mass engagement into opportunities for better health communication and governance. Those efforts have produced results. The question of what the World Cup can do for global health is not unanswered; it has generated a body of institutional work that deserves to be examined on its own terms.”
“The 2026 World Cup is over. The Ebola outbreak in the DRC is not. Spain will defend their title in 2030. Between now and then, the question of what a global sporting event of this scale can contribute to global health, and what institutional arrangements can credibly deliver on that potential, deserves more serious attention than it has so far received. The final whistle has blown on the tournament. On this other game, it has not.” (5)
“An estimated 6.5 million fans from around the world converged in the three host countries, bringing their passion, enthusiasm and, possibly, germs. Overlapping with Independence Day celebrations, large gatherings were common, as well as the backdrop of concurrent international disease activity, including the Ebola and Hantavirus outbreaks.
Infectious disease can easily spread in large crowds, and experts were already looking at wastewater, a possible uptick in hospital visits and social media for any signs of a potential outbreak.
Diseases like measles are always a top concern. As of July 16, there were 2,260 confirmed measles cases in the U.S., according to the CDC.
“The matches drew the world’s attention. The work that kept them healthy did not — and that was the point,” the CDC said in a news release Sunday.
The CDC’s effort included a World Cup data dashboard that provided health departments with real-time data on disease trends across multiple cities as fans and teams traveled throughout the tournament, as well as around-the-clock health operations at U.S. ports of entry in coordination with U.S. Customs and Border Protection to monitor international passengers.
The agency also deployed its experts to strengthen disease surveillance, laboratory capacity, wastewater surveillance and preparedness planning in host cities.
In all, the agency coordinated across a broad network, including multiple CDC divisions, the Department of Health and Human Services (HHS), the Administration for Strategic Preparedness and Response (ASPR) and the White House FIFA World Cup Task Force.
In March, the CDC released guidance providing health officials with a framework for preparing for a broad range of threats, including biological, chemical, radiologic/nuclear, environmental and mass casualty incidents.
The guidance encouraged every jurisdiction to approach the tournament through a risk-based lens, recognizing that travel between venues connects communities far beyond the host cities.
The tournament is over, but the work is not. The same preparedness, surveillance and partnerships that supported the World Cup are part of CDC’s readiness and response mission every day of the year, continuing through the close of the activation on July 31 and well beyond.” (6)
“The event’s official clinical provider, Cedars-Sinai, interviewed on Monday Casey Batten, chief medical officer for the Los Angeles Games, about the care plan designed for the sporting spectacle, covering everyone from athletes to fans and volunteers
The medical organisation of the LA28 Olympic and Paralympic Games is moving forward on a central premise: it is not simply about reacting to injuries, but about building a healthcare network capable of operating simultaneously in the Village, the training centres and the competition venues spread across the region. Batten, also co-director of Nonoperative Orthopaedics and Sports Medicine at Cedars-Sinai Orthopaedics and Sports Medicine, explained that his task is to oversee the entire medical infrastructure that will provide coverage for the various groups involved. “Ultimately, the role of the chief medical officer is to oversee all of the medical infrastructure delivered to all stakeholders—including athletes, coaches, their entourages and spectators”, he said.
One of the core elements of such system will be the polyclinic located in the Olympic and Paralympic Village, designed primarily to care for athletes and those staying there during the Games, including coaches and support staff. But the model does not end there. The care plan will extend to training sites and competition facilities, each with its own staffing, coordination and preparation needs. For Batten, the challenge lies in ensuring that all these spaces function as parts of a single system, connected and ready to respond to very different scenarios.” (7)
“Major Outbreaks at Global Sporting Events
-New York City 2022, Polio (wastewater detection), Silent spread detected through environmental surveillance
-Tokyo Olympics 2020,COVID-19, Games delayed a year; 800+ cases despite extensive protocols
-PyeongChang Winter Olympics 2018, Norovirus, 1200+ workers quarantined; military deployed to fill gaps
-London Athletics Championships 2017, Norovirus, Athlete withdrawals; venue disinfection
-Rio Olympics 2016, Zika Virus, 100+ athletes withdrew; global travel fears; $7–18B in economic losses
-Super Bowl XLIX -2015, Measles, Linked to Disneyland outbreak; transmission fears at major
-Brazil World Cup 2014, Dengue, Malaria, Chikungunya, Vector control ramped up; dengue clusters reported
-Vancouver Olympics 2010, STIs, Spike in STI screenings; public health condom campaigns
-South Africa World Cup 2010, Measles, Regional outbreak raised global concerns; spotlight on vaccination gaps
-Germany World Cup 2006, STIs, Notable surge in testing demand across clinics” (8)
1.Behind the Scenes: How PAHPA Enables ASPR to Support National Special Security Events, https://www.aspr.gov/readiness-response/response-operations/behind-scenes-how-pahpa-enables-support-national
2.Statement on CDC Public Health Readiness & Response for the FIFA World Cup 2026™, https://www.cdc.gov/media/releases/2026/statement-on-cdc-public-health-readiness-response-for-the-fifa-world-cup-2026.html
3.Medical preparedness and critical care for the 2026 FIFA World Cup, by Jesse Sherratt, DO; Zein Kattih, MD; Vikramjit Mukherjee, MD, https://www.chestphysician.org/medical-preparedness-and-critical-care-for-the-2026-fifa-world-cup/
4.Sports fever! Getting the ball rolling to prevent infections at the World Cup™ and beyond, by Preeti Mehrotra et al, https://pmc.ncbi.nlm.nih.gov/articles/PMC13104518/
5.The other final whistle: World Cup, Ebola and global health’s unfinished game, by Wu Yanni, Zhou Qing’an, https://news.cgtn.com/news/2026-07-30/The-other-final-whistle-World-Cup-and-global-health-s-unfinished-game-1PcPCLticTu/p.html
6.CDC reveals massive behind-the-scenes public health operation that kept FIFA World Cup fans safe, By Louis Casiano, https://www.foxnews.com/health/cdc-reveals-massive-behind-the-scenes-public-health-operation-kept-fifa-world-cup-fans-safe
7.LA28 prepares co‑ordinated health roadmap, https://www.insidethegames.biz/articles/la28-prepares-a-coordinated-health-roadmap
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curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai