Playing Defense Against Special Pathogens: A National Special Pathogen System (NSPS) Tabletop Exercise Helps Prepare the Nation for the Largest World Cup in History
Nationwide
January 10, 2025
Quick Look
Background
The 2026 Federation Internationale de Football Association (FIFA) World Cup is a global event anticipated to attract millions of international visitors to the United States, increasing the risk of special pathogen transmission.
Response
In preparation for these multi-city mass gatherings, the ASPR-funded National Emerging Special Pathogens Training and Education Center organized a national tabletop exercise to test and improve special pathogen readiness. Exercise planners organized more than 515 participants by region and tasked them with tracing an infected patient’s movement; identifying appropriate isolation, testing, and transport strategies; and validating coordination across the National Special Pathogen System.
Impact
The exercise established strong partnerships and identified and addressed gaps in regional testing capabilities, strengthening local, state, regional, and national readiness to respond to and mitigate special pathogens.
In June 2026, when North America hosted the largest Federation Internationale de Football Association (FIFA) World Cup, it wasn’t just the athletes and fans making history. With 48 nations competing in 104 matches across 16 cities in three countries, the event's size and global attendance also created distinct health care and public health challenges.
Behind the roar of the crowds, the United States has an unprecedented opportunity to test and strengthen its defenses against special pathogens. Special pathogens are high consequence infectious diseases (HCIDs) that, if contracted, can make people severely ill, have high mortality rates, and for which there are limited medical countermeasures or treatments. With increased global travel and large crowds expected during the 2026 World Cup, special pathogens may spread more quickly and pose a risk to national health security.
Anticipating these challenges, the Administration for Strategic Preparedness and Response (ASPR) funded Coordinating Body of the NSPS, the National Emerging Special Pathogens Training and Education Center (NETEC), organized a first-of-its-kind national tabletop exercise focused on a World Cup scenario to test and improve special pathogen readiness across the nation.
The NSPS prepares the health care delivery system to protect communities and the health care workforce and respond to special pathogen events nationwide. NETEC supports the NSPS by coordinating high-quality special pathogen care through a tiered network of health care entities across the United States, including 13 NSPS Level 1 or Regional Emerging Special Pathogen Treatment Centers (RESPTCs) and public health and EMS organizations.
In October 2024, NETEC assembled a planning committee for the World Cup exercise, which included representatives from all Regional Emerging Special Pathogen Treatment Centers. The planning committee provided the Regional Emerging Special Pathogen Treatment Centers with the flexibility to address local needs through and the ability to test their own plans and regional capabilities against a standard scenario. The committee met biweekly to coordinate logistics and resources, identify partners for outreach, and design an exercise based on the Middle East Respiratory Syndrome (MERS).1
On January 10, 2025, more than 515 participants from all 13 Regional Emerging Special Pathogen Treatment Centers, as well as federal, state, and local health care organizations and public health departments, emergency medical services, and health care coalitions, came together to conduct the exercise. NETEC created 11 separate breakout groups — one for each Department of Health and Human Services region and one for national-level coordination—each navigating a scenario involving a patient with a suspected MERS case near a World Cup site. Each region completed three modules:
Module 1: Early symptoms and laboratory testing
Module 2: Safe transport of infected patients, particularly at-risk populations such as children and older adults
Module 3: Coordination with other components of the NSPS and engagement with the media and the public.
Through these modules, participants practiced their roles, collaborated with the appropriate partners, tested their plans for strengths and weaknesses, and identified solutions to strengthen their collective response.
After the exercise, participants collectively debriefed to identify strengths and areas for improvement. For many regions, the exercise revealed gaps in laboratory capacity, highlighting the need for increased testing capabilities to provide timely diagnosis, treatment, and infection control. To mitigate this gap, numerous regions have convened laboratory working groups, collaborating with regional partners to improve testing capacity and coordination.
"When you see the patient quickly identified, when you see where NETEC comes in, where the Regional Emerging Special Pathogen Treatment Centers engage and support response and how it all of works together, that's when you're truly seeing how important it is to have a national system like this and the opportunity to save lives, protect communities and healthcare workers.”
Former National Special Pathogen System Executive Director
The exercise brought together partners across health care, emergency response, and public health for a rare collaborative effort. With all 10 Health and Human Services regions testing their special pathogen plans simultaneously, regional leaders exchanged challenges and promising practices to enhance nationwide preparedness. Participants shared expertise, formed new relationships, clarified roles, and coordinated response strategies—benefits extending beyond special pathogen events to any emergency. Like soccer, effective defense against pathogens relies on practice, teamwork, coordination, and communication.
Learn more about the National Special Pathogen System 2026 World Cup Tabletop Exercise.
1. Citation-Khan S, El Morabet R, Khan RA, Bindajam A, Alqadhi S, Alsubih M, Khan NA. Where we missed? Middle East Respiratory Syndrome (MERS-CoV) epidemiology in Saudi Arabia; 2012-2019. Sci Total Environ. 2020 Dec 10;747:141369. doi: 10.1016/j.scitotenv.2020.141369. Epub 2020 Aug 3. PMID: 32791417; PMCID: PMC7398055