World Cup Poses Litmus Test for US Public Health Infrastructure

The FIFA World Cup kicking off next month in the US, Canada, and Mexico will serve as a litmus test for how the US is able to handle potential disease threats, amid cuts to the Centers for Disease Control and Prevention’s workforce and funding, a surge in measles cases, and the emerging threat of Ebola.

“The risk is not any different than it is in other World Cups that we’ve managed properly, and the United States has systems in place to make sure that if something happens that we respond appropriately,” said Jay Bhattacharya, currently the top official at the CDC, speaking on CBS News last week.

Despite assurances, there has been skepticism the response has been enough to mitigate a possible public health disaster.

Sen. Bill Cassidy (R-La.) questioned federal preparedness to handle a measles outbreak during a Senate Health, Education, Labor, and Pensions Committee hearing last month with Health Secretary Robert F. Kennedy Jr.

“Tourists from all over the world will come to the United States. Unfortunately, some of them will bring vaccine-preventable diseases like measles,” said Cassidy, the committee’s chair. “What steps is HHS taking to address the outbreaks that may arise from the World Cup and the folks coming here?”

Kennedy defended the US measles response, leaving Cassidy unsatisfied that his “question wasn’t answered.”

“I can tell you we are laser-focused on that. We have testing booths and institutions all over the games,” said Kennedy.

Federal Response

The CDC and the Administration for Strategic Preparedness and Response have been involved in some coordination efforts, but much of the work falls on local health departments.

“I think the majority of the coordination work for a lot of kind of the detailed logistics and operations for local response does happen at the local level, but where appropriate our state and federal partners have absolutely been involved,” said Monika Roy, deputy health officer and infectious disease and response branch director for the County of Santa Clara’s Public Health Department, which will host World Cup games.

The CDC has briefed localities and posted event-specific guidance for the attendees this month, and ASPR hosted a webinar this year on how the Medical Reserve Corps and health coalitions can aid in planning.

The CDC has “put on a number of web-based resources for us around preparation for some of the various things we might see there,” said Marcus Plescia, director of the Fulton County Board of Health, which serves most of Atlanta, another host city. “I’ve found them to be responsive and also forward-thinking and quite helpful as we prepare.”

One of the CDC’s presentations focused on surveillance and monitoring to be aware of international outbreaks. Planners are also considering the vaccination rates for the host countries and of the home countries for most fans.

“That’s an area where our federal partners have actually helped us in the preparedness and planning,” said Roy, during a call hosted by the Big Cities Health Coalition, whose members cover 9 of 11 US host cities.

The rapidly evolving situation with Ebola presents an additional challenge.

The CDC issued a suspension order May 18, limiting travel by individuals who had been in the Democratic Republic of the Congo, Uganda, or South Sudan during the previous 21 days, citing the threat of Ebola.

The DRC is slated to play Portugal in Houston on June 17.

“We’re actively working with FIFA to ensure that there is safe traveling, safe passage and ensuring that travelers and the American public remain safe throughout,” said Satish K. Pillai, incident manager for CDC’s Ebola response, during a press call Tuesday.

But others acknowledged worries over the US hantavirus response.

Krutika Kuppalli, associate professor of internal medicine at UT Southwestern Medical Center and an infectious disease expert, said she is concerned that US health agencies weren’t publicly involved and communicating regular updates to the public, unlike the World Health Organization, she said.

While FIFA and WHO are continuing to collaborate ahead of the event, the US formalized its exit from the global health group in January.

But, the US can use hantavirus as a learning opportunity to improve public health strategies, said Kuppalli, who has been involved with state and local health preparations in Texas.

Good communication and surveillance will be essential to detect potential threats and to share that information with attendees and their contacts, she said.

Last month, the CDC halted diagnostic testing of some infectious diseases including rabies and mpox.

“If we’re potentially trying to prepare for having an increase in different types of infectious diseases, but while simultaneously cutting back on being able to test for them, that’s a very concerning thing,” Kuppalli said.

State and Local Preparation

Nearly all localities reported not receiving supplemental public health money ahead of the World Cup.

“There has been no additional funding from the federal government to assist with that preparedness or response. Much of that is happening at the state and local level,” said Celine Gounder, an infectious diseases specialist and former adviser to President Joe Biden’s Covid-19 transition team, during a press call May 8.

That means, she said, there will be more variability in how prepared state and local health departments will be and what mitigation tools they will have.

States have assessed how to prepare for different disease threats such as an outbreak of respiratory illnesses, vaccine-preventable diseases, or sexually transmitted infections, or counter extreme heat or a bioterrorism event.

It also involves scaling up medical staff, lab testing capabilities, rapid mass communications, wastewater surveillance, contact tracing, and hospital capacity.

Host cities have expanded food inspection capacity and established cooling centers for extreme heat.

“There have been some resources associated with the World Cup, but that has not, at least in our community come to public health,” said Philip Huang, director and health authority for Dallas County Health and Human Services. “We’re worried about the continuation of the public health infrastructure grants and other funding.”