FIFA World Cup 2022 Challenges

We believe the organisation and public health prevention policies adopted during the Tokyo OG/PG were appropriate, with some understandable gaps and lessons learnt related to big events to be revised and optimised. Comparisons between public health policies implemented in Japan and those contemplated for the FIFA World Cup 2022 in Qatar are summarised in table 1. In contrast to the fan-free Japan OG, which hosted around 118 000 visitors over 29 days (ie, around 0.5% of the country’s population), in the FIFA World Cup 2022, Qatar is expected to welcome foreign fans equivalent to more than half of the country’s total population.5

Rigorous infection control policies to limit transmission of COVID-19 at the FIFA World Cup 2022 is a priority currently under development by public health experts with a review of past experiences in Qatar. More than a year has passed since the Amir Cup (December 2020) in Qatar with around 20 000 spectators attending.6 7 Qatar also successfully held 77 matches throughout the Asian Football Cup in December 2020 with a smaller number of fans. This was done within a tight bubble system for players and their respective delegations that set a standard for the safe restoration of professional football globally.1 6 7 Undoubtedly, accommodating a tournament with such a huge number of fans like the FIFA World Cup 2022 will necessitate more robust security measures to protect players, spectators and residents.6 7

New variants of concern

In November 2021, the WHO reported ‘Omicron’’ (ie, variant B.1.1.529) as a new strain to the COVID-19.8 Omicron has the capability to increase transmissibility, grant resistance to treatments and partially evade infection or vaccine-induced immunity.1 Further gene mutations associated with the emergence of new variants are expected to affect virus characteristics and capabilities such as transmissibility, sickness severity and immune evasion, creating major uncertainty about the pandemic.1 Using the Omicron strain as an example, the virus evolved in such a way that it became more contagious and less severe than previous versions.8 In this context, the greater the number of people infected with a virus, the more likely it will mutate into new strains. Omicron, as well as the other COVID-19 variants, could mutate into a more dangerous, severe form, resulting in increased fatalities, imposing a significant case load on the world and decreasing the likelihood of the FIFA World Cup 2022 being successfully hosted. On the other hand, Omicron/other variants could evolve into a less severe form, allowing the FIFA World Cup 2022 to be safely held and filled with spectators.

Recommendations for FIFA World cup 2022

Given the experience gained from the Tokyo OC/PG, we suggest additional preventative measures be considered, including (1) a mandatory vaccination certificate showing second dose or booster dose within 6 months (number of doses depending on the vaccine durability effectiveness) and/or a recent COVID-19 infection certificate (within the last 6 months: protective adaptive immunity following natural infection of SARS-CoV-2 may persist for at least 6–8 months)9; (2) a mandatory COVID-19 immunoglobulin G antibody titre greater than 33.8 BAU/mL (which is suggestive of protective immunity against COVID-19) before boarding to Qatar10; (3) a COVID-19 passport for athletes, delegates and spectators that includes information about previous exposure to the virus, testing, results,and vaccination status1; and (4) providing free COVID-19 rapid test centres for spectators around each stadium and directly pairing these results in the spectator COVID-19 passport and geolocalisation application prior to entering the premises.

Given the scarce evidence regarding the long-term persistence of immunity in either vaccinated or previously infected individuals, the aforementioned measures should provide further protective approaches in reducing the rate of COVID-19 infection during mass gathering. From now until the FIFA World Cup 2022, predictions remain uncertain in terms of the emergence of new variants rendering vaccines infective. However, the rapid spread of the less severe Omicron variant across the globe is bringing hope toward herd immunity. Taken together, we remain optimistic that the FIFA World Cup 2022 will be held safely and with full spectator attendance to witness the ‘beautiful game’.