Millions of people are about to pack stadiums across the U.S., Canada and Mexico for the World Cup, starting June 11.
Public health officials have been working to ensure the health and safety of the masses of fans they're expecting at the 104 matches across 16 cities through mid-July.
In the U.S., World Cup preparations are coming in a time of a diminished federal health presence and funding. It's upped the workload for host city health departments, as they're also strapped for federal funding.
Nevertheless, World Cup host city health officials say they're prepared for the many challenges that come with large-scale celebrations and gatherings.
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"We've been focusing on expecting the expected" — issues related to weather, health and human behavior, says Dr. Marcus Plescia, district health director for Fulton County, Georgia, which includes Atlanta.
Planning for the event is ongoing, says Dr. Philip Huang, director of Dallas County Health and Human Services in Texas. "To be able to begin preparations a year out is a luxury for us, compared to a lot of the situations that we deal with," he says.
"We call Atlanta 'Hotlanta' for a reason"
For public health departments, the World Cup is a big deal –- but they're well prepared for the biggest challenges.
Summer heat, for instance. "We call Atlanta 'Hotlanta' for a reason," says Georgia's Dr. Plescia, "It's going to be hot and humid here -– so heat-related injuries are going to be an issue."
Atlanta is hosting eight World Cup matches and the team from Uzbekistan. At downtown Centennial Olympic Park, a month-long fan festival is expected to draw some 15,000 people a day. Cooling stations will offer air-conditioning and hydration.
Then there's feeding the crowds. "The biggest lift for us and for all health departments is that our environmental health workers have to inspect all of the food vendors –- and there will be a whole lot of food vendors," Plescia says.
Inspectors will check every day to ensure the facilities are in working order and the food is safe to eat. "We want to make sure that people feel confident that they can go out to eat and have a good time –- and they don't have to worry about getting food poisoning," Plescia says.
When lots of people gather, germs tend to spread. "We're worried about sexually transmitted infections because there's going to be a lot of people here and it's going to be a festive atmosphere," Plescia says. "And then we're worried about things maybe we wouldn't have been worried about as much before, particularly measles." Measles is highly contagious among those who haven't been vaccinated, and there have been 30 U.S. outbreaks this year.
Dallas is hosting nine World Cup matches — the most of any city. The health department is stepping up disease surveillance in wastewater, expanding sites and covering more area, says Dr. Huang, the county health authority. Beyond looking for typical threats like influenza and COVID, they're also testing for "whatever might appear" through genomic sequencing, he says.
They're also broadening mosquito surveillance –- setting insect traps and testing for pathogens they can spread. "We always test for West Nile virus," Huang says, "But we're also increasing our testing for dengue, chikungunya and Zika because of all the [incoming] international travel."
Medical staff are also looking out for symptoms of Ebola or hantavirus, due to outbreaks.
Keeping track of which diseases are circulating means they'll be able to alert hospitals and the public quickly if they see a spike. "It's a lot of things we normally do but certainly more enhanced," Huang says.
They're also preparing health tips for the public in different languages: Wear a hat and sunscreen and hydrate when it's hot out. Bug spray and long sleeves help prevent mosquito bites. Stay home if you're sick. "It's the same messages [we always share], but it's really concentrated because we've got so many people coming during a hot period of time in Dallas," Huang says.
"Most of our staff are not taking vacations"
The World Cup finals are jointly hosted by New York and New Jersey on July 19.
Officials have been running practice simulations to prepare for outbreaks and mass casualty events. "We plan for the worst case scenario and go through it before it actually happens," says Dr. Alister Martin, New York City's health commissioner.
They've also set up "incident command" to "divert resources from normal stuff so that we can manage any potential emergencies," Martin says, adding that the operation will continue through much of the summer, for other big events planned in New York, including America's 250th anniversary, Pride month and the Puerto Rican Day parade.
In Los Angeles, which is hosting eight games, including the U.S. opening match versus Paraguay, risk-assessment teams will monitor the surroundings for chemical exposures and biological threats.
In L.A., diminished federal assistance means the health department is counting on existing staff to do the extra work. "Most of our staff are not taking vacations during the month of the World Cup because they'll need to work -– we'll be obviously accruing overtime costs," says Barbara Ferrer, the L.A. county health director.
And much of their regular work, like routine food inspections, gets put aside. "I know it would be easier if we weren't in a resource constrained environment," Ferrer says. "But I want to provide assurance that even in a resource constrained environment, we're well prepared."
Ferrer says they've successfully planned and managed other events of national significance, like the 2022 Super Bowl. "This work isn't new to us," she says, adding that staff are making great efforts "to make sure this is a joyous time in L.A. county and [that] we're all safe."
This year's experience will better prepare Los Angeles to host other events, she says — like the 2027 Super Bowl and the 2028 Summer Olympics.
Ferrer hopes these events will help authorities see that public health is key to public safety — and worth investing in.
Less of a federal presence
On the federal level, the Centers for Disease Control and Prevention, which serves as the nation's public health agency, has a muted presence this year.
"Usually, the CDC is a visible lead when we have international events in the United States, particularly across the country, versus just in a single state," says Dr. Debra Houry, former chief medical officer for the CDC who resigned last year.
The current Trump administration has pushed thousands of workers out of the CDC workforce and tampered politically with some of its functions, such as setting vaccine policy and publishing scientific papers. The agency's scientists rarely speak directly with the public anymore; their messages are filtered through politically appointed leadership.
Other governmental groups that would typically be involved, such as the National Security Council's biosecurity group, the Office of Pandemic Preparedness and Response Policy, and the Assistant Secretary for Preparedness and Response, have been disbanded, left vacant or don't have permanent leaders, Houry says.
The diminished federal presence serves as the backdrop for the World Cup.
Emily Hilliard, press secretary for the Department of Health and Human Services which oversees the CDC and ASPR, wrote in an email response to NPR: "HHS and the Centers for Disease Control and Prevention (CDC) are actively coordinating with state, local, and global partners to ensure public health and safety during FIFA World Cup 2026 and enhance any measures, as needed."
Localities have found that the federal presence is late in coming, and not as coordinated as it may have been in the past, says Lori Freeman, CEO for the National Association of County and City Health Officials, which represents health departments.
Freeman says the CDC started holding coordination calls and issuing some guidance a few months ago –- long after host cities started their own preparations. She notes: "When it comes to merging public health, emergency response and preparedness, that is an area we worry constantly about because the federal government is the agency that must manage across state jurisdictions between and among states."
Some have stepped up to fill perceived gaps. For instance, Georgetown University has set up a Health Security Operations Center to track infectious diseases and send out daily reports, to inform places expecting an influx of travelers throughout the World Cup.
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