Sewage Surveillance Goes Mainstream
Americans back World Cup wastewater disease tracking — and some say it's a reason to attend.
Public sentiment on wastewater surveillance at the 2026 World Cup
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Executive summary
Wastewater surveillance is having a mainstream moment — and the 2026 FIFA World Cup is its biggest test yet. As the U.S. battles its worst measles outbreak in decades, a new survey finds that nearly three in four Americans support health experts analyzing sewage and medical records to catch disease outbreaks before they spread through packed stadiums.
The numbers are striking for an era of collapsed institutional trust. Nearly half of respondents — 49.6% — called the approach "smart public health planning," while only 2.8% flagged it as too much surveillance. That gap between support and skepticism is wider than most public health professionals might expect given the post-COVID trust environment.
For event organizers, there's a commercial signal buried in the data: 28.6% of respondents say health monitoring would make them more likely to attend a major international event. Only 14.3% say it would deter them. Visible, expert-led safety infrastructure, the data suggest, is becoming a feature — not a liability.
The Georgetown University Health Security Operations Center running this surveillance is itself historic: the first non-governmental public health emergency operations center ever deployed for a mass gathering, covering all 16 World Cup host sites and expecting up to 6.5 million international travelers.
Context
When 6.5 million international travelers converge on 16 U.S. cities for the 2026 FIFA World Cup, they bring their home countries' disease profiles with them. That's not a hypothetical — it's exactly the scenario that prompted Georgetown University's Health Security Operations Center to build something that has never existed before: a non-governmental public health emergency operations center for a mass gathering.
The Georgetown HSOC integrates wastewater DNA and RNA sequencing, social media monitoring, and clinical health records across every host city, generating daily briefings for FIFA and local health authorities. Its pathogen watchlist includes measles, SARS-CoV-2, influenza, dengue, and Ebola — a roster shaped by real-world outbreak intelligence, not theoretical risk models.
The urgency is well-founded. The CDC reported 2,030 confirmed measles cases in the U.S. through early June 2026, spanning 40 jurisdictions — a nearly 8x increase from all of 2024. PAHO issued a formal health advisory for World Cup travelers just days before the tournament opened, specifically warning that stadiums and fan zones are "particularly high-risk" environments where a single infected person can expose up to 18 unprotected individuals.
This survey, fielded in June 2026 with 141 U.S. respondents, captures public sentiment toward the wastewater surveillance approach at exactly the moment it is being deployed at scale. The four-question study probed support levels, trust in health experts, free-form concerns, and whether health monitoring would affect decisions to attend major international events.
The backdrop matters for interpreting the results: as of April 2025, only 42% of U.S. adults expressed at least some confidence in federal health agencies to respond to infectious disease outbreaks, according to KFF — a historic low shaped by partisan polarization and post-COVID institutional damage. That makes the survey's support numbers considerably more surprising, and the trust dynamics considerably more important to understand.
Findings
Nearly Three-Quarters Back Sewage Surveillance — Even in a Low-Trust Era
The headline number is 74.4%: the combined share of respondents who are either "very" or "somewhat" supportive of health experts analyzing wastewater and health records to detect outbreaks during the World Cup. Nearly half of all respondents — 49.6% — chose the strongest possible endorsement: "it's smart public health planning."
To put that in context: this level of support exceeds the 62% of Americans who backed temperature checks during COVID-19 in a 2020 PLOS ONE study — and far outpaces the 42% who supported government contact-tracing apps. The framing appears to matter enormously. When surveillance is presented as expert-led and collective-safety-oriented rather than government-mandated tracking, resistance drops sharply. Only 2.8% of respondents called the approach "too much surveillance" — a remarkable figure for a country where institutional trust in health agencies is near historic lows.
The free-response data add texture without dramatically changing the picture. Most open-ended answers expressed either no concern or mild curiosity. A small cohort surfaced data governance worries — specifically whether collected information could be misused or compromised — but this concern was more latent than expressed. The gap between the 2.8% who actively flagged surveillance overreach and the broader anxiety visible in open-ends reflects a structural tension: the public is comfortable with the idea of wastewater monitoring but hasn't yet engaged deeply with questions of who controls the data afterward.
Takeaway: Would health monitoring influence your decision to attend a major international event?
Takeaway: Would health monitoring influence your decision to attend a major international event?
Data Governance Trust
Opinions diverge on whether the health data gathered will be trustworthy and free from corruption versus concerns about misuse or unreliable data.
Hover over dots to see real answers.
Respondents split sharply on whether health data collected at large events will be handled responsibly or risks misuse and overreach.
Highlighted answers
- Collected data will be used responsibly and securely
“Zero concern. Smart.”
Blunt endorsement reflects the surprisingly wide gap between supporters and skeptics found in the survey data.
- Collected data will be used responsibly and securely
“Simply that they are safe and well regulated”
Conditions trust on proper oversight, mirroring the majority who see expert-led surveillance as a public health feature.
- Collected data may be misused or compromised
“Privacy and data security concerns.”
Concisely names the core tension that persists even among those who broadly support disease monitoring at mass gatherings.
- Collected data may be misused or compromised
“I am concerned it will be another COVID-19 style media hype governmental overreach campaign”
Captures post-COVID institutional distrust that the article identifies as the backdrop against which 73% support is striking.
- Collected data may be misused or compromised
“Misused of the information & invasion of privacy.”
Represents the strongest skeptic pole, linking data misuse and privacy invasion as twin fears about health surveillance.
Conclusion
The 2026 World Cup wastewater surveillance program is running a live experiment in public trust — and right now, the results are better than most public health leaders had reason to expect. Nearly three-quarters of Americans support the approach, and a meaningful share say it would actively bring them to the stadium. In a moment defined by institutional skepticism, those numbers represent a genuine opening.
The question is what happens next. Georgetown's HSOC operation is already being cited as a potential template for the 2028 Summer Olympics in Los Angeles. If it performs — if wastewater signals catch an early outbreak, trigger a targeted response, and keep fans healthy — the model gains a proof-of-concept that could reshape mass-gathering public health for a generation. If data governance questions go unanswered and a post-tournament controversy emerges around how health records were used, the fragile trust this survey captures could erode quickly.
The practical prescription is clear: pair the technical infrastructure with enforceable data governance rules, communicate the expert track record early and often, and treat the 28.6% of people who see health monitoring as a reason to attend as an audience worth speaking to directly. Visibility, in this case, is the point — not the problem.
Takeaway: Would health monitoring influence your decision to attend a major international event?
No, it wouldn't affect my decision
Yes, it would make me more likely to attend
Yes, it would make me less likely to attend
Other
Takeaway: Would health monitoring influence your decision to attend a major international event?
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