The 2026 FIFA World Cup, which begins this week, is expected to bring millions of visitors from dozens of countries to the United States. I have tickets to the World Cup finals next month, and I’m finding it hard to contain my excitement at my opportunity to watch what I know will be the pinnacle of competition in a sport loved by billions of fans worldwide.

But as a doctor, I can’t help but think about how dangerously unprepared the United States is to meet the public health demands of hosting the largest sporting event in U.S. history. The World Cup will bring with it significant public health risks, bringing people from all corners of the world together, where infectious diseases can easily travel and become amplified in enclosed, semiconfined spaces such as stadiums, bars and restaurants.

As a doctor, I can’t help but think about how dangerously unprepared the United States is.

I know firsthand how infectious diseases spread in mass gatherings. As a Muslim performing the Hajj in Mecca, I saw some people contract meningitis, and I was one of the countless others on that spiritual pilgrimage who became infected with an upper respiratory infection. Mass gatherings of the size of the Hajj or the World Cup provide ideal conditions for infectious diseases, heat illness, crowd injuries and foodborne outbreaks to occur.

As a practicing physician who writes and speaks about public health, I have little confidence that the U.S. is prepared for the part of its World Cup-hosting duties that includes ensuring the safety of the health of millions of visitors.

The World Cup comes to a United States that remains scarred by the Covid-19 pandemic. There’s rising mistrust of vaccines, worsening healthcare staff shortages and the re-emergence of infectious diseases that had been eliminated. More than 2,000 cases of measles in the U.S. this year serve as a reminder of what happens when public health information officials such as Health and Human Services Secretary Robert F. Kennedy Jr. traffic in misinformation instead of work to preserve public health. Thanks in no small part to Kennedy, vaccine hesitancy is on the rise, and the kindergarten rate of vaccination is below the 95% rate necessary to confer protection upon the larger community.

Although a recent hantavirus outbreak on a cruise ship on the Atlantic posed a low risk to the general American public, if it had gotten out of hand, the U.S. would not have been prepared. If cases had spread across the country, we would not have been able to sufficiently test and identify cases because the lab test that detects the virus is only available at a handful of special laboratories throughout the country. And the silence from HHS and the Centers for Disease Control and Prevention was worrisome. Because public health only succeeds when and where there is clear, transparent communication, officials at those agencies should have held a national press briefing to answer the public’s questions. But they didn’t. According to an Annenberg Public Policy Center poll from March, only 43% of Americans trust public health communications from federal agencies.

The pillars of a strong public health infrastructure are early recognition of diseases, clear communication and trust, all of which appear to have been eroded lately. That’s why it seems unlikely that the U.S. could respond effectively to a major public health threat on our soil during the World Cup or at any time in the near future.

There’s little evidence that the U.S. implemented a proactive approach to the World Cup.

Our public health infrastructure has been underfunded for decades, surveillance systems have been gutted, and hundreds of critical CDC and HHS workers have been laid off. The greatest threats to a successful World Cup, then, may not be terrorism or violence, but an inability to manage predictable health emergencies at scale.

There’s little evidence that the U.S. implemented a proactive approach to the World Cup. To the contrary, it appears the country will react passively if havoc occurs. A proactive approach would have included strengthening infectious disease monitoring at airports, improving hospital surge planning, investing in public health infrastructure such as vaccine research, and rebuilding trust through transparency.

When I look at my World Cup tickets, I am filled with excitement, but I can’t shake the feeling that our country isn’t prepared for public health crises that may occur in the coming weeks.

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