The 2026 FIFA World Cup, the largest mass gathering event in U.S. history, is set to take place across three countries and 16 cities over 39 days. While the event has received significant attention and funding for security, public health preparedness remains a concern. As an infectious disease physician and epidemiologist, I highlight several gaps in the tournament's preparation that could have serious consequences.
The Missing Command Center
The key to managing public health during mass gatherings is a centralized command center with real-time data flowing in every five minutes. Dr. Ziad Memish, a former health security manager for the Hajj, emphasizes the importance of a single chain of command. However, the 2026 World Cup, spread across three countries, will lack such a command structure. This absence raises concerns about the ability to coordinate a swift and effective response to any public health emergencies.
No Federal Public Health Funding
The federal government allocated $625 million for law enforcement and security, but zero for public health. This decision is troubling, as it means local health departments in host cities are left to prepare for a massive international event without dedicated federal funding. Health directors in Dallas, Kansas City, Boston, and Seattle confirmed the lack of additional federal public health funding, leaving them to rely on their own resources.
Lack of Risk Assessment and Briefings
The CDC has not conducted a World Cup-specific national risk assessment, instead deferring broader coordination questions to the White House task force. The White House task force has also failed to provide biological threat briefings to relevant committees, raising concerns about the level of preparedness. This lack of proactive risk assessment and briefings could leave the country vulnerable to unexpected health crises.
Measles Outbreak in Kansas City
Measles was detected in Kansas City's wastewater in mid-May, indicating a potential outbreak. This is a serious concern, as measles typically appears in emergency departments five to seven days after it is detected in wastewater. The continued transmission of measles in the U.S. highlights the country's lack of preparedness for a deadly biological emergency.
MERS and Hantavirus Concerns
The National Special Pathogen System modeled a MERS outbreak during a tabletop exercise, identifying gaps in cross-city coordination and rapid case identification. MERS could easily become a super-spreader event in a busy emergency department or stadium. The lack of a standardized rapid diagnostic panel for MERS further complicates detection and response.
Host City Challenges
Host cities are facing their own challenges, with fans planning unsanctioned encampments lacking running water or sanitation. This situation mirrors a hepatitis A outbreak in San Diego in 2017. Local health departments are being asked to prepare for a massive event without dedicated federal funding, leaving them vulnerable to outbreaks.
Workarounds and Coordination
In the absence of federal public health coordination, universities and the U.S. military have stepped in. Georgetown University's Health Security Operations Center and the Armed Forces Health Surveillance Division have produced valuable data and analysis. However, these efforts are not centralized, and there is no enforcement authority to compel jurisdictions to act.
Global Health Challenges
The World Cup coincides with concurrent outbreaks of Ebola in the Democratic Republic of the Congo and hantavirus in South America, straining global response capacity. The U.S. has issued a Title 42 order to bar entry to those who have been in affected areas, but the impact on the tournament's preparedness is already evident.
Conclusion: A Call for Improved Preparedness
The 2026 FIFA World Cup presents a unique challenge for public health preparedness. The absence of a centralized command center, dedicated federal funding, and proactive risk assessment could have serious consequences. It is crucial for the U.S. to address these gaps and enhance its preparedness to ensure the health and safety of all those involved in this massive international event.
