Experts Warn US Is Unprepared for Public Health Outbreak at the 2026 World Cup

The 2026 FIFA World Cup kicks off on June 11 across 16 host cities in the United States, Mexico, and Canada. Over 5 million tickets have been sold for 104 matches spanning 39 days — making it the largest mass gathering event in American history, dwarfing the 3.4 million total attendance at the 2022 Qatar World Cup [1]. It arrives at a moment when the World Health Organization has declared a global health emergency over Ebola, measles cases in the U.S. have already surpassed 2,000 for the year, and the CDC has lost nearly a third of its staff [2][3].

The federal government responded to the security challenge with $625 million through FEMA's FIFA World Cup Grant Program, funding police, counterterrorism, and cybersecurity across 11 U.S. host cities [4]. The amount allocated specifically for public health: zero [1].

The Funding Gap

FEMA confirmed that its $625 million grant program covers "security activities such as training, staff background checks, cybersecurity and increased police and emergency response," but that activities related to "public health, biosecurity or food safety are not typically funded through these grants" [1][4].

Source: FEMA / Sports Illustrated

Data as of Jun 1, 2026CSV

Health directors in Dallas, Kansas City, Boston, and Seattle all confirmed to Sports Illustrated that they received no additional federal public health funding for the tournament [1]. This stands in contrast to the 2022 Qatar World Cup, where the host government partnered directly with the WHO to create a comprehensive health security framework that embedded epidemiologists and surveillance systems into event planning from the outset [5].

The gap extends beyond event-specific funding. The CDC's overall budget faces a proposed 53 percent reduction for FY2026, from $9.2 billion enacted in FY2024 to $4.3 billion proposed [6]. The Public Health Emergency Preparedness program — the primary federal mechanism for strengthening state and local outbreak response — faces a 52 percent cut [6]. Federal agencies also clawed back $12 billion in previously approved COVID-19 era grants that had been supporting disease monitoring, laboratory capacity, and emergency preparedness infrastructure [6].

Source: TFAH / CDC Congressional Justification

Data as of May 1, 2026CSV

About 80 percent of the CDC's domestic budget flows to states, localities, and tribal organizations, and federal funding accounts for roughly half of state and local health department budgets [6]. Cuts at the federal level translate directly into fewer epidemiologists, contact tracers, and lab technicians at the city level — precisely the people who would detect and contain an outbreak during the tournament.

A Depleted CDC

The CDC entered 2026 having lost approximately 3,000 employees, with an additional 1,300 on administrative leave — a reduction of roughly 33 percent of its civil service staff since January 2025 [3][7]. The cuts hit core outbreak response capabilities: the Epidemic Intelligence Service lost at least 30 coordinating staff and 40 officers in training, and more than 130 employees were laid off from the office directing the National Center for Immunization and Respiratory Diseases [7].

As of June 2026, there is no permanent CDC director, no U.S. surgeon general, no head of the Office of Pandemic Preparedness and Response Policy, and no permanent Assistant Secretary for Preparedness and Response [1][8]. The National Security Council's biosecurity group has been disbanded [8].

The CDC has not conducted a World Cup-specific national risk assessment, instead telling local health departments to "identify priority risks for their jurisdiction" and deferring broader coordination questions to the White House task force [1]. That task force, according to Sports Illustrated, delivered zero biological threat briefings to the Senate Homeland Security Committee [1].

The Disease Landscape

The tournament opens against a backdrop of multiple active infectious disease threats.

Measles is the most immediate concern. The CDC confirmed 2,030 U.S. cases as of June 4, 2026 — approaching the full-year total for 2025 and representing an order-of-magnitude increase from the 284 cases recorded in all of 2024 [2]. Measles is one of the most contagious infectious diseases known: a single infected traveler at Denver International Airport in 2025 triggered an outbreak of at least 10 secondary cases [2]. Kansas City detected measles in wastewater in mid-May, a signal that typically precedes emergency room cases by five to seven days [1]. The city hosts six matches and four national team training camps.

Source: CDC

Data as of Jun 4, 2026CSV

Ebola draws the most headlines but poses a lower direct risk. In May 2026, the WHO declared a global health emergency over a Bundibugyo strain outbreak in the Democratic Republic of Congo and Uganda, which kills roughly one in three people it infects [2][9]. The U.S. banned entry from affected countries [2]. Because Ebola spreads only through direct contact with bodily fluids and infected people are not contagious before showing symptoms, experts assess the risk of stadium transmission as "very low" [9]. The greater concern is whether the U.S. health system could handle even a single imported case: nationally, there are only 26 biocontainment beds across 13 regional treatment centers [1]. Bellevue Hospital in New York City — the closest facility to the World Cup Final venue at MetLife Stadium — has two beds rated for hemorrhagic fevers and 10 for respiratory pathogens [1].

Respiratory viruses remain a persistent threat. The 2025-2026 flu season reached a 30-year high, and COVID-19 continues to cause an estimated 290,000 to 450,000 hospitalizations annually in the U.S. [9]. Respiratory transmission is amplified in stadiums, fan festivals, airports, and transit systems where fans congregate.

Mosquito-borne diseases are a particular concern for southern host cities during peak summer. Dengue set a U.S. record in 2024 with nearly 3,800 cases — a 359 percent increase over the 14-year average [9]. The Oropouche virus exploded across Latin America in 2024 in its largest recorded epidemic, with over 8,000 confirmed cases in Brazil alone; no vaccines or treatments exist [9]. Dallas County has expanded its insect surveillance beyond West Nile virus to include dengue, chikungunya, and Zika, using genomic sequencing to identify emerging pathogens [10].

MERS (Middle East Respiratory Syndrome) presents a detection challenge. Standard diagnostic panels do not test for it, detection requires the specialized Laboratory Response Network, and most clinicians would not think to order the appropriate test [1]. Dr. Krutika Kuppalli, a Dallas-based infectious disease physician, warned that "travel history needs to be a vital sign" during the tournament [1].

Who Is Filling the Void

With the federal public health apparatus diminished, an improvised network of academic institutions, private health systems, and military units has stepped in.

Georgetown University and MedStar Health launched a Health Security Operations Center that will operate throughout the tournament, pulling data from more than 30 partners and producing daily reports for DHS and the White House [8][11]. The center monitors disease transmission data across all 16 host cities in real time. It is staffed by 12 to 17 people, including graduate and undergraduate students [8]. It has no enforcement authority.

The Armed Forces Health Surveillance Division created country-by-country importation risk maps — an assessment the CDC never conducted [1].

A voluntary wastewater surveillance working group formed among host cities, but with no centralized federal coordination [1]. Dallas County's wastewater system now tracks SARS-CoV-2, dengue, chikungunya, Zika, and West Nile virus, though its BioWatch system was not fully operational as of early June [1][10].

Massachusetts activated its Emergency Operations Center and detailed health care planning specific to the tournament, including hospital surge coordination [12].

Dr. Jennifer Nuzzo, director of the Brown University Pandemic Center, told Sports Illustrated: "If you ask whether the U.S. is prepared for a deadly biological emergency, continued measles transmission gives you a very clear answer — no" [1].

How This Compares to Past Events

The contrast with recent international sporting events is stark. For the 2022 Qatar World Cup, the host government signed a formal partnership with the WHO more than a year before kickoff, embedding public health objectives into stadium design, food service, and crowd management. That partnership left behind "trained personnel, tested coordination systems, and a governance model linking health, sport and urban-infrastructure authorities," according to the WHO [5][13].

Qatar later shared its framework with the Paris 2024 Olympic organizers, who built their own centralized health security command [13]. Dr. Ziad Memish, who managed health security for the Hajj for years, told Sports Illustrated that the key to mass gathering health security is "a single chain of command and real-time data flowing to a central command center every five minutes." He added: "When you have too many independent partners working independently, that's not going to fly" [1].

The 2026 World Cup has no such unified command. Local health departments began their own preparations well before the CDC started holding coordination calls a few months ago [1].

The January 2025 tabletop exercise run by the National Special Pathogen System — which simulated a MERS outbreak during the World Cup — identified gaps in cross-city coordination, rapid case identification, and surge capacity [14][15]. With 8 out of 10 HHS regions containing at least one host city, the exercise underscored the geographic scale of the coordination challenge [15].

Historical precedents for outbreaks at major sporting events are real but limited. The 2010 Vancouver Olympics saw two measles cases infect 82 people. The 2006 World Cup in Germany produced a norovirus outbreak. The 2024 Hajj resulted in over 1,300 heat deaths and a meningococcal outbreak [1]. A systematic review published in PLOS ONE found that mass-gathering-related respiratory disease outbreaks in the U.S. are "relatively rare," with 72 outbreaks over a 10-year period, and that major sporting events detected "only marginal increased incidence of all infectious diseases" [16]. That said, the review also noted significant gaps in quantitative evidence and called for more rigorous surveillance during contemporary events [16].

The Weakest Links

Not all host cities enter the tournament equally prepared. Texas is the only host state scoring "low" on national preparedness rankings, lacking both Public Health Accreditation Board and Emergency Management Accreditation Program accreditation [1]. Texas hosts two cities — Dallas (nine matches) and Houston — among the busiest venues.

Houston faces a compounding problem: the state threatened to pull approximately $110 million in public safety grants because of the city's immigration ordinance, which Mayor John Whitmire warned "could affect emergency operations and World Cup-related readiness" [17].

Kansas City confronts a housing shortage that is pushing fans into unsanctioned encampments, raising sanitation and disease transmission concerns [1].

Heat is an additional variable. Atlanta, hosting eight matches, has planned cooling stations and hydration services at fan festivals expecting 15,000 daily attendees [10]. The combination of summer temperatures and dense crowds increases the risk of both heat-related illness and vector-borne disease transmission in southern venues.

Who Pays If Something Goes Wrong

FIFA's hosting agreements place the financial burden squarely on host cities. A Springer Nature analysis of the contracts found that "downside risk is localized, while control over the event remains centralized," with agreements that "shift extensive liabilities onto the host city while reserving expansive powers" for FIFA [18]. Indemnification language is not reciprocal: cities must defend and hold FIFA harmless, but FIFA does not extend the same protection to host cities [18][19].

FEMA's grant program covers security costs, but public health expenses — hospital surge staffing, disease surveillance, laboratory testing, vector control — fall to city and county budgets that are already absorbing federal funding cuts [1][4][6].

This structure creates what public health scholars describe as a misaligned incentive: the entity controlling event operations (FIFA) bears limited financial exposure for health failures, while the entities bearing financial exposure (host cities) have limited control over event operations. Whether this delays outbreak response is speculative, but the contractual framework does not reward early, aggressive public health intervention by either party.

The Case for Calm

Organizers and federal officials push back on the alarm. FEMA says it has coordinated training for more than 238,000 local emergency managers and first responders in host cities [4]. FIFA states it is "aware and monitoring" the Ebola outbreak and working with all three host governments [2]. The Ready.gov website offers safety toolkits for communities [4].

Some epidemiological evidence supports measured optimism. The PLOS ONE systematic review found that single-day mass gatherings — like individual matches — have never produced a reported outbreak in the U.S. dataset [16]. The duration and density of contact matters: a 90-minute match in an outdoor stadium presents a different transmission profile than a week-long indoor conference or a multi-day religious pilgrimage.

The 2022 Qatar World Cup, despite occurring during active COVID-19 circulation and drawing 3.4 million fans, did not produce a documented large-scale outbreak [5]. This may reflect the effectiveness of Qatar's WHO partnership — or it may reflect the inherent difficulty of attributing post-event infections to specific gathering exposures. The evidence base, researchers acknowledge, has significant gaps [16].

Dr. Matthew Jude Boulton, an epidemiologist at the University of Michigan, noted in a Frontiers in Public Health review that major sporting events "detected only marginal increased incidence of all infectious diseases including influenza, with infections primarily limited to specific groups" [16].

What Happens If It Goes Wrong

If a novel pathogen or drug-resistant outbreak were detected mid-tournament, the legal and logistical pathway for halting or relocating matches is unclear. FIFA retains operational authority over the tournament schedule, while state and local officials hold public health police powers — including quarantine authority — under their respective jurisdictions [18]. There is no pre-established trigger threshold for cancellation.

During COVID-19, the legal landscape for sports cancellations was largely shaped by force majeure clauses in contracts and executive emergency orders from governors and mayors [20]. The 2020 Tokyo Olympics were postponed by mutual agreement between the IOC and the Japanese government, not by unilateral action from either party [20]. No appellate court has ruled on the specific question of governmental authority to cancel a FIFA-sanctioned event for public health reasons [20].

The absence of a designated incident commander for biological threats — distinct from the security-focused FEMA coordination — means that mid-tournament public health decisions would be negotiated in real time among FIFA, the White House task force, FEMA, the CDC, and 16 independent local health departments. Dr. Memish's assessment of that scenario: "That's not going to fly" [1].

What Remains at Stake

The 2026 World Cup is a stress test for American public health infrastructure at a moment when that infrastructure is under historic strain. The tournament may pass without a significant outbreak — most mass gathering events do. But the margin for error has narrowed. The CDC has fewer people. Host cities have less federal support. The disease environment includes an active Ebola emergency, record measles transmission, a 30-year flu season high, and expanding mosquito-borne threats.

The question is not whether the risk is high in absolute terms — peer-reviewed evidence suggests it is moderate. The question is whether the systems designed to detect and contain an outbreak, should one occur, are adequate. The federal government's own tabletop exercise identified gaps [15]. Its own funding decisions left public health at zero [4]. And its own workforce reductions removed the people who would staff a response [3][7].

A Georgetown-MedStar academic center and a handful of volunteer wastewater networks are not substitutes for a coordinated federal public health operation. They are evidence of its absence.