Mass gatherings, such as the upcoming Winter Olympics in Sochi or the FIFA World Cup in Brazil, place great stress on a country's safety and security systems. Media coverage of such events often examines the logistical challenges facing the host country.
But one of the greatest concerns receives little media attention. When hundreds of thousands or even millions of people congregate in one place, there can be acute risks to public health and enormous pressure on the public health system. And there may be a significant potential for the gathering to contribute to the international spread of disease, ranging from meningitis, measles, or polio to pandemic influenza.
Health experts are well aware of these concerns even if most attendees are not. The World Health Organization uses the International Health Regulations as a framework to provide guidance to event organizers and local authorities so they can manage risks and build their capacity to prevent and respond to health emergencies. These regulations, which constitute legal rights and obligations for the 196 countries (including the United States) that have signed on to them, serve to strengthen national disease prevention, surveillance, and control and response systems as well as public health security in travel and transport.
At a December 2013 meeting in New York of the Business Council for the United Nations, a program of the UN Foundation, Ambassador Abdallahyahya Al-Mouallimi of Saudi Arabia described the extensive activities undertaken for the arrival of more than 3 million people for the Hajj, the Islamic pilgrimage to Mecca and the largest gathering of Muslims in the world every year. The logistical challenges are huge, of course, but so are the health concerns. The Saudi Ministry of Health issues health regulations that include particular vaccination requirements related to polio and yellow fever, and it recommends that all visitors for the Hajj be vaccinated against seasonal influenza.
Most other governments, however, are not as practiced as Saudi Arabia in the hosting of mass gatherings. When their turn comes, they need to look beyond the immediate concerns and use the opportunity to build systems and core competencies related to preparedness, disease surveillance, and coordination between the health sector and other areas so there is a lasting "health legacy" from the event.
Mass gatherings often generate political momentum and resources, and they present an important opportunity to build sustainable and long-term health improvements in four areas: improved medical and hospital services; a strengthened public health system; an enhanced living environment; and increased health education and awareness. Amidst all the preparations for such a huge event, the health legacy may be one of the most important results.
To fully develop such a legacy, the engagement of a whole-of-society approach -- encompassing governments, international organizations, civil society organizations, the private sector, and industry associations -- is required. Public-private partnership is traditionally a very positive collaboration accompanying mass gatherings, and it applies to health just as it does to other areas.
So should you avoid such large-scale gatherings out of fear? Prudent travelers to the upcoming Winter Olympics will be undaunted. But you should ensure that you are up-to-date with recommended routine vaccines and adult boosters, including the measles vaccine and the seasonal flu vaccine. You also should take precautions to consume safe food and water and to protect yourself and others from the spread of germs and flu-like illnesses.
And, of course, you should enjoy the games.