The risk that an Ebola-infected traveler could arrive in the United States during the 2026 World Cup that began last week is low, but not zero, and if that happens, American hospitals are ready to respond, the country’s infectious disease experts say.
It wasn’t always like this.
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During the 2014 West African Ebola outbreak, a Liberian, Thomas Eric Duncan, arrived at a Dallas hospital with Ebola symptoms and was turned away before being admitted.
Two nurses were infected but survived.
That generated $260 million in U.S. funding for Ebola preparedness and response training and 13 specialized treatment centers, all aimed at helping hospitals safely identify, isolate and care for suspected Ebola patients.
“We’re not going to be able to prevent 100% of infections, but we’re certainly better prepared than ever,” said Dr. Gavin Harris, an expert on serious communicable diseases at Emory University in Atlanta, one of the 11 World Cup host cities in the United States.
Public health officials and hospitals in U.S. host cities have been preparing for a variety of infectious disease threats as 6.5 million fans travel across North America during the 39-day event that includes 104 matches in the U.S., Mexico and Canada.
The US Centers for Disease Control and Prevention (CDC), the Pan American Health Organization and the World Health Organization (WHO) have described the Ebola risk to World Cup host countries as low, citing the diseases, COVID-19 and influenza, which spread when large crowds gather, as the most likely threats.
But the Ebola outbreak in the Democratic Republic of the Congo (DRC), which has infected more than 675 people and killed more than 135, remains a cause for concern.
“The risk of contracting Ebola for anyone attending the World Cup is extremely low. Ebola is not airborne and does not spread through casual contact – it requires direct contact with the bodily fluids of someone who is sick,” said Dr. Tom Frieden, executive director of Resolve to Save Lives and former director of the CDC.
“But a low level is not zero, and it will not be zero until the outbreak is stopped at its source in the Democratic Republic of the Congo.”
Ebola preparedness efforts in the United States that began in 2015 were born from a collaboration between Emory University, the University of Nebraska Medical Center and NYC Health + Hospitals/Bellevue in New York City, facilities that cared for Ebola patients during the Ebola outbreak in West Africa, the largest to date.
“It was recognized that we had a duty to train other facilities to recognize potential patients who might be exposed or sick with something like Ebola,” Emory’s Harris said.
Since then, thousands of healthcare workers have been trained to recognize and treat patients with Ebola and other serious pathogens.
For the World Cup, preparation experts have conducted nationwide training exercises simulating a possible MERS outbreak at the games.
They have also compiled guidance for doctors, raising awareness about diseases that are not typical of their hometowns, including mosquito-borne diseases such as malaria, dengue and chikungunya.
The United States, Mexico and Canada have instituted airport screenings and travel bans that restrict the entry of noncitizens who have recently traveled to countries affected by the outbreak, and the United States has invited Europe to impose similar restrictions. Harris said such bans are likely to decrease the chances of Ebola at World Cup venues.
To comply with U.S. restrictions, the Democratic Republic of Congo’s national soccer team left the country in May and trained in Belgium before traveling to the United States.
In each host city, FIFA, local public health officials and hospital systems have formed medical committees that have been conducting threat assessments of Ebola and other infectious diseases based on the teams playing in their cities, prevalent diseases in their home countries, visa restrictions and stadium logistics, Harris said.
Some areas have discussed providing site-specific disease treatments or protective equipment and are using surveillance tools, including wastewater monitoring, air quality data and electronic medical records, to detect unusual disease clusters.
FIFA said medical risks are assessed as part of overall tournament planning and are managed in close coordination with host cities, which provide medical leaders to oversee and coordinate services.
It said it is monitoring the Ebola outbreak and is in contact with sports and health authorities in the Democratic Republic of the Congo and the three host countries.
Dr. Michael Osterholm, an infectious disease expert at the University of Minnesota, said planning for mass gatherings in the United States is not new.
“State and local health departments working closely with the CDC have for many years been at the forefront of people entering this country,” he said.
To assist with disease tracking and coordination, Georgetown University has created an independent Health Security Operations Center, in collaboration with more than 30 public and private sector entities.
More than 700 state and local health authorities have subscribed to the group’s daily reports, as have about 60 federal partners, FIFA and the CDC.
Still, staff cuts at the CDC, the United States’ departure from the WHO and the pressure on state and local health departments that have been battling the largest disease outbreak in the United States in decades have taken their toll, Frieden and two other experts said.
“My biggest concern is whether a CDC that has lost thousands of employees has the capacity, support and mandate to act quickly enough, both here and in the DRC,” Frieden said.
The U.S. Department of Health and Human Services, which oversees the CDC, did not respond to a request for comment.
Jeanne Marrazzo, executive director of the Infectious Diseases Society of America, said Health Secretary Robert F. Kennedy Jr.’s public health cuts have led to an exodus from government agencies.
“However, we know that the people who are still there are working around the clock in many cases to try to keep us safe,” he said at a briefing.
