In the lead-up to the FIFA World Cup, a collaborative of public health groups is leveraging innovative tools like wastewater surveillance to monitor pathogens and prevent the spread of disease during this massive soccer event. This effort, led by the Health Security Operations Center (HSOC) at Georgetown University, is an independent civil society initiative with over 30 collaborators. While the onus of public health preparation typically falls on the host country, the U.S. public health infrastructure has been significantly weakened in recent years, and the Trump administration's withdrawal from the World Health Organization has further complicated matters. Rebecca Katz, PhD, MPH, the director of HSOC, emphasizes the importance of this collaborative effort, noting that it is the first time a nongovernmental entity is working independently to support public health monitoring during a global event. The CDC is utilizing a range of surveillance methods, including syndromic surveillance, laboratory data, wastewater surveillance, traveler-based genomic surveillance, and event-based intelligence. One of the key tools is wastewater surveillance, which has gained popularity during the COVID-19 pandemic. This method is simple, cost-effective, and can track almost any pathogen. Anthony Maresso, PhD, a professor of virology and microbiology, explains that wastewater surveillance is like weather radar, helping decision-makers respond to probable threats. The HSOC is receiving daily situation reports from partners like Verily, Biobot Analytics, SecureBio, and WastewaterSCAN, who are providing data and analyses. These partners have 50 sites across the country, testing for 20 infectious diseases multiple times a week. WastewaterSCAN, for instance, has baselines and knows annual averages and seasonal trends, which can help clinics and hospitals prepare for surges. Vindell Washington, MD, MS, chief physician executive at Verily, highlights the importance of wastewater surveillance in quickly identifying changes in pathogens that could impact public health. Katelyn Jetelina, PhD, MPH, a communication partner of HSOC, will be explaining wastewater trends alongside other public health analyses on her popular newsletter, Your Local Epidemiologist. The World Cup, which kicks off on June 11 and ends on July 19, will see millions of fans traveling to attend games in 11 U.S. cities and some locations in Canada and Mexico. The participating teams also have base camps in North American cities, including Houston, Texas, which is partnered with the Democratic Republic of the Congo, where an Ebola outbreak is raging. While measures are in place to prevent Ebola's spread into the U.S., metagenomic wastewater surveillance would help detect it early. Marisa Donnelly, PhD, director of epidemiology at Biobot Analytics, notes that the World Cup is a test case to show the system that they built for wastewater monitoring. However, the project has little funding, and most collaborators are contributing using their own resources, which may not be sustainable in the long term. This initiative raises important questions about the future of public health monitoring during large-scale events and the role of independent civil society efforts in filling gaps left by weakened public health infrastructure.
