As the FIFA World Cup opens in North America, an independent surveillance network plans to monitor pathogens in community wastewater across 16 host cities, sending daily alerts to public health officials and identifying risks ranging from measles and COVID-19
When the World Cup kicks off in North America this week, millions of bodies will move through the same spaces—stadiums, hotels, transit hubs. The excitement is the point. But the physics of crowding is harder to ignore.
An anticipated five million soccer fans will travel to 16 host cities across three countries to cheer on teams from packed stands. For public health experts. that scale creates a scenario where germs can spread faster than hospitals can always keep up with. Their answer is happening quietly underground: wastewater.
Dozens of health organizations and research groups have formed an independent surveillance network to track dangerous pathogens in community wastewater as a kind of sentinel signal for potential outbreaks. The network is coordinated by the Health Security Operations Center in Washington. D.C. and will monitor typical pathogens such as measles. SARS-CoV-2—the virus that causes COVID—and influenza. It will also look for concerning but less likely threats. including 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.
Behind the science is a practical, daily rhythm. The public health intelligence hub—launched by experts at Georgetown University and the health company Medstar Health—will work with wastewater monitoring sites. biotech companies (including Verily Health). genomics labs. and local public health departments. Communities and local health officials are set to receive daily reports, along with notices of any significant risks.
Vindell Washington, chief physician executive at Verily, puts the problem in everyday terms. “The World Cup is the Super Bowl on steroids,” he says. People are arriving from different countries with different baseline disease prevalence. he adds. and when you put people in close proximity. “for folks to have a safe environment. this kind of monitoring strategy is super important.”.
That coordination is not simple. The event spans multiple host cities and three different countries. and the tournament requires coordination with and participation from the 48 countries and regions with participating teams. Katz says the exchange of health data across regions is already complex, and the current U.S. public health landscape has made it even harder. “The relationship between United States and the World Health Organization is complicated,” Katz says, noting that the U.S. formally exited from the international health agency this year. Her team created a nongovernmental public health operations center to fill the gap.
Wastewater monitoring is built on a straightforward idea: communities leave traces. Viral or other pathogenic DNA can be shed through feces. urine. or other bodily fluids and then enter municipal wastewater systems. Detecting that genetic material can sometimes reveal community spread days—or even weeks—before cases spike at hospitals and health care systems. That lead time can help public health teams isolate sick people, administer vaccines, and roll out treatments.
Marc Johnson. a wastewater detective at the University of Missouri who also collaborates with SecureBio. describes the role wastewater can play. “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. ” he says.
The approach has been tested before. Wastewater data bolstered outbreak response and preparedness during the peak of the COVID pandemic. 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 will focus primarily on the cities hosting matches. but researchers say the World Cup’s movement patterns make it more complicated than a typical city-by-city campaign. Johnson explains that visitors won’t necessarily be randomly distributed. 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. ” he says.
To handle that complexity, the monitoring network can identify multiple 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: SARS-CoV-2. influenza. measles. respiratory syncytial virus (RSV). and norovirus. Many monitoring sites rely on rapid polymerase chain reaction (PCR) testing. which can pick up very tiny amounts of viral DNA.
Washington says PCR testing is fast enough to matter. “PCR testing is really fast. ” he says. adding that teams can sample. test. and then turn around results within a roughly three-day period to provide “a snapshot [of] whether a pathogen is prevalent and how prevalent the disease is in the community.”.
Genome sequencing can add another layer by showing which variant or lineage is present. SecureBio can sequence a genome in five days. but the genetic analysis can reveal information that helps trace outbreaks and understand disease spread. Johnson gives the kind of comparison the team hopes to make: “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. ’” he says.
The network is also designed to look beyond the expected. It will keep tabs on mpox, certain other sexually transmitted diseases, and insect-borne illnesses such as dengue and chikungunya. It is also set up to sniff out other viruses of recent concern. Johnson notes that his dashboard includes a page for “unexpected findings. ” covering Ebola-causing virus and hantavirus—an outbreak that recently affected a cruise ship. though it is not thought to spread easily.
“We are not doing anything targeted,” Johnson says. “So, whether you were expecting it or not, it would show up in our readout.”
Wastewater data will be only one piece of the picture. The center will also collect climate and deidentified electronic health record data. Teams will 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 coordinating closely with the Pan American Health Organization to exchange information with health officials in Canada and Mexico.
The effort is built around the same tension that fans feel in the stands: the World Cup is meant to bring people together. At the same time, it brings pathogens together faster than most systems are designed to move. Wastewater provides an early signal. clinical care provides confirmation. and the data pipeline—daily reports. rapid PCR. and genome sequencing—tries to close the gap.
Katz frames it with a note of reassurance about the purpose of all this work. “The World Cup is fun. and it’s an exciting opportunity to be able to watch some good sports and cheer on teams. ” she 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.”.
World Cup FIFA wastewater surveillance pathogens measles SARS-CoV-2 influenza Ebola dengue mpox PCR testing genome sequencing public health intelligence Georgetown University Verily SecureBio CDC Pan American Health Organization