In April, a Dutch-flagged cruise ship, the MV Hondius, experienced a major outbreak of hantavirus, so far resulting in three deaths and others ill. The World Health Organization (WHO) has indicated that some human-to-human transmission may have occurred on board the cruise ship. That said, the “risk to the general public is low,” according to Dr. Maria Van Kerkhove, WHO Acting Director for Epidemic and Pandemic Preparedness and Prevention. “This is not a virus that spreads like flu or like COVID. It’s quite different,” Dr. Maria Van Kerkhove added.
An infectious outbreak elsewhere would not normally be of great concern for the United States, but, with millions of sports-related visitors arriving in a concentrated period from every corner of the world, it must be.
For U.S. public health officials, the incident is a reminder of how quickly a rare pathogen can cross borders and how global mobility can outpace global surveillance. It presents a test of whether the United States, three years after the official end of the COVID-19 public-health emergency, has truly rebuilt the systems meant to detect and contain dangerous diseases at its borders.
The outbreak has prompted an assessment of vulnerabilities as both the COVID-19 experience and the hantavirus event have exposed structural weaknesses in U.S. border health operations, namely, fragmented authority, inconsistent reporting, and reliance on voluntary compliance by airlines and cruise operators.
The FIFA Factor
In just weeks, the 2026 FIFA World Cup will bring millions of athletes, staff, and spectators from around the world to 16 U.S. host cities. It will be the largest sporting event ever held on American soil — and the largest mass-migration of international visitors since before the pandemic.
The Patchwork at the Border
The United States does not have a single agency responsible for monitoring infectious diseases at its borders. Instead, it has many agencies with different missions, priorities, and capabilities. Over the past decade, given this diffusion of responsibility, the U.S. Government Accountability Office has issued multiple reports warning that the United States lacks a unified strategy for border health security. What is in place is as follows:
The Centers for Disease Control and Prevention (CDC) oversees public-health screening and disease surveillance. Its Division of Global Migration and Quarantine is responsible for preventing the introduction of communicable diseases into the United States. It operates quarantine stations at 20 major airports and seaports, but the agency does not have the authority to screen every traveler or require airlines to conduct health checks. Rather, it relies on voluntary reporting by airlines and cruise lines, targeted screening during known outbreaks, and post-arrival monitoring when a specific exposure is identified.
In 2025, there were significant initial reductions in force that were reversed, but CDC staff levels remain lower than before, with experienced experts retiring due to the current organizational environment.
Further, the Trump Administration’s FY 2026 budget request shows that CDC is not favored, with a submission to Congress of only $4.243 billion in discretionary budget authority compared to more than twice that amount requested for FY 2025.
Customs and Border Protection (CBP) is an agency of the U.S. Department of Homeland Security (DHS). It manages ports of entry and enforces customs and immigration laws. CBP officers are the first federal officials most travelers to the U.S. encounter. The officers are trained to identify visible signs of illness, but they are not medical professionals and are not equipped to conduct meaningful health assessments during high-volume travel periods. Their authority is limited to referring travelers to the CDC when something appears wrong.
Immigration and Customs Enforcement (ICE), also an agency of DHS, oversees detention facilities and supports DHS-wide emergency planning. It is not a public health agency, but, in theory, plays a role in disease prevention through coordination during large-scale international events.
For the FIFA World Cup, ICE’s role is primarily logistical. This, despite it being the highest-funded U.S. law enforcement agency, with $85 billion now at its disposal. (ICE leads President Trump’s immigration crackdown, sending thousands of agents into U.S. communities.)
The U.S. Public Health Service Commissioned Corps is a small team of roughly 6,000 professionals whose mission includes responding to emergency public health needs, including disease outbreaks.
A Public Health Perspective of the FIFA World Cup
Public health experts warn that mega-events create ideal conditions for the spread of disease because of dense crowds, rapid intercity travel, international mixing, burdens on local health systems, and increased demand for emergency services.
The good news is that in 2025, the CDC began working with local health departments in all 16 host cities of FIFA events to prepare for health-related illnesses, foodborne outbreaks, and respiratory infections. On the not-good-news side, airport screening, temperature checks, questionnaires, and visual assessments have limited effectiveness. Studies published after the COVID-19 pandemic found that such measures rarely detect asymptomatic or pre-symptomatic travelers.
Moreover, the U.S. is still recovering from the COVID-19 pandemic, which exposed deep weaknesses in its public health infrastructure, including local health capabilities. A 2025 report from the National Association of County and City Health Officials found that many local health departments remain understaffed and under-resourced. (The Administration has chosen to reduce relevant financial support significantly.)
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And Cruise Ship Visitors
Cruise ships have long posed a challenge for public health authorities. They combine large numbers of international passengers with limited onboard medical facilities and variable reporting practices. The CDC’s Vessel Sanitation Program (VSP) oversees cruise-ship health standards, but its authority applies only to ships that call at U.S. ports. Some FIFA visitors who arrive first in Mexican or Canadian ports are not subject to VSP oversight.
The current Hondius outbreak highlights these vulnerabilities because that ship traveled through remote regions, stopped at more than one country, and passengers disembarked and reboarded at multiple ports.
In essence, outbreaks on foreign-flagged vessels traveling outside U.S. waters whose passengers come to the FIFA Cup games in the U.S. may not be reported to U.S. authorities.
Where Matters Stand
CDC has updated guidance to airlines and cruise operators regarding the reporting of unusual respiratory illnesses. DHS has held interagency planning meetings focused on World Cup contingencies. Local health departments have conducted tabletop exercises simulating outbreak scenarios.
That said, as the run-up to the FIFA World Cup begins, the United States faces a paradox: the risk of a major outbreak is low, but the consequences of a failure are high. Although the public health system may be stronger than it was in 2020 during the COVID-19 pandemic, pathogens do not respect borders. The test for the system will probably come from an unexpected, possibly unknown, threat.
Whether the Trump Administration has sufficiently prepared federal health entities and provided adequate support to local health systems to identify, prevent, and respond to a serious health crisis will be before the American people and the world to judge. Let’s hope it is up to it.
Editor’s Note: The opinions expressed here by the authors are their own, not those of impakter.com — In the Cover Photo: Fans at the Brazil vs. Croatia match at the 2014 FIFA World Cup, June 12, 2014. Cover Photo Credit: Wikimedia Commons.
