This week the International Federation of Association Football (FIFA) World Cup kicks off in North America. An anticipated five million soccer fans from around the world will travel to 16 host cities across three countries to cheer on teams from packed stadiums, creating a perfect petri dish for disease spread.
Dozens of health organizations and research groups have formed an independent surveillance network to track the presence of dangerous pathogens in community wastewater—a sentinel for potential outbreaks. The network, coordinated by the Health Security Operations Center in Washington, D.C., will monitor typical pathogens such as measles, SARS-CoV-2 (the virus that causes COVID) and influenza, as well as concerning but less likely threats such as the pathogens that cause dengue fever and Ebola—which is fueling an ongoing outbreak in the Democratic Republic of the Congo.
“Mass gatherings are complicated. This particular mass gathering is about as complicated as you can possibly imagine,” says Rebecca Katz, global health security expert at Georgetown University and director of the Health Security Operations Center.
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The public health intelligence hub, launched by experts at Georgetown University and the health company Medstar Health, is working with wastewater monitoring sites, biotech companies, genomics labs and local public health departments to stay ahead of disease threats during the matches. Communities and local health officials will receive daily reports, as well as notices of any significant risks.
“The World Cup is the Super Bowl on steroids,” says Vindell Washington, chief physician executive at Verily Health, a company collaborating in the network. People are coming from different countries with different baseline disease prevalence, he says, “so if you’re putting people in close proximity, for folks to have a safe environment, this kind of monitoring strategy is super important.”
Three different countries are hosting the multiweek event, which requires coordination with and participation from the 48 countries and regions with participating teams. The exchange of health data across regions is already complex, but the current public health landscape in the U.S. has made coordination even more challenging, Katz says.
“The relationship between United States and the World Health Organization is complicated,” Katz says. (The U.S. formally exited from the international health agency this year.) “Our colleagues in local, state and federal health departments are stretched,” she says, adding that her team wanted to fill the gap by creating a nongovernmental public health operations center.
Wastewater monitoring sites can sense levels of disease in a community by detecting pieces of viral or other pathogenic DNA shed through feces, urine or other bodily fluids into municipal wastewater systems. These data can sometimes reveal community spread of a pathogen days or even weeks before cases spike at hospitals and health care systems. That can buy public health experts more time to start isolating sick people, administering vaccines and rolling out treatments—ultimately saving lives.
“This isn’t meant to replace clinical surveillance but to complement it—to give you sort of an unbiased readout of the whole community, as opposed to individual patients,” says Marc Johnson, a wastewater detective at the University of Missouri, who also collaborates with SecureBio, one of the organizations partnering on the project.
Wastewater data bolstered outbreak response and preparedness during the peak of the COVID pandemic, for example. It was also used during the 2022 World Cup in Qatar, the 2024 Summer Olympic Games in Paris and political conventions in the U.S.
This year’s tracking efforts will focus primarily on the cities hosting matches, but the researchers will be on high alert for patterns of disease spread that could be unique to the 2026 games. Visitors won’t necessarily be randomly distributed, Johnson explains. Fans will likely travel to cities where their country’s team is playing—and may even follow teams across North America from site to site throughout tournament stages. “In terms of the influx and the granularity to [the World Cup], there’s just nothing else like it,” Johnson says.
The researchers can detect numerous pathogens that are common and uncommon to the U.S. Verily, for instance, has real-time dashboards for each host city that track five of the most relevant and prevalent viruses, including SARS-CoV-2, influenza, measles, respiratory syncytial virus (RSV) and norovirus. Many of the monitoring sites rely on rapid polymerase chain reaction (PCR) testing, which can pick up very tiny amounts of viral DNA.
“PCR testing is really fast,” Washington says. “We have the ability to sample, test and then turn around, within a roughly three-day period, a sample that gives you a snapshot [of] whether a pathogen is prevalent and how prevalent the disease is in the community.”
Genome sequencing viruses in samples can drill down even further. SecureBio can sequence a genome in five days, but the genetic analysis can reveal much more information, such as a virus’s variant or lineage. Such data can be helpful in tracing and linking outbreaks to better understand disease spread.
“We would potentially be able to say, ‘Aha, we’ve detected measles, and it is or is not the same as the [viral variant] that you found in another location,’” Johnson says.
The network will also keep tabs on mpox, certain other sexually transmitted diseases and insect-borne illnesses such as dengue and chikungunya. The network is also set up to sniff out other viruses of recent concern. Johnson’s dashboard, for instance, has a page for “unexpected findings,” which includes Ebola-causing virus and hantavirus (which recently caused an outbreak on a cruise ship but is not thought to spread easily).
“We are not doing anything targeted,” he says. “So, whether you were expecting it or not, it would show up in our readout.”
In addition to wastewater information, the center will collect climate and deidentified electronic health record data. Teams will also monitor social media for conversations about potential infections among fans. If a particular pathogen spikes in a community, the Health Security Operations Center will alert partners at local health departments and the Centers for Disease Control and Prevention. The team is also coordinating closely with the Pan American Health Organization to exchange information with health officials in Canada and Mexico.
“The World Cup is fun, and it’s an exciting opportunity to be able to watch some good sports and cheer on teams,” Katz says. “There’s a whole infrastructure and organization of people and entities behind the scenes trying to make sure that everybody can be as safe and enjoy things as much as possible.”
