Soccer matches in Middlesbrough, England, were canceled in 1897 due to smallpox, and games in Blackburn, England, were postponed in 1965 to prevent the spread of poliovirus. In 2001, hand foot and mouth disease halted equestrian events and the Six Nations rugby tournament in England. And in 1918, while Major League Baseball played on to increase American morale as threats mounted due to influenza and global instability due to war, the season was eventually shortened, ending in early September. More recently, in 2016, Major League Baseball games were relocated out of Puerto Rico to Miami due to fears concerning Zika virus transmission.
Sports especially bring tens of thousands of athletes and spectators together in a single location. And while, historically, concerns about disease over the past century remained localized, the emergence of new, more deadly infectious diseases has brought new people and institutions into the planning process. Decisions regarding large sporting events have shifted from event organizers to governments and international organizations, reflecting both a dramatic shift in organizational structures in sports and the global challenge of public health in the 21st century.
Infections have been around since before the development of international sport competition in the second half of the 19th century. Yet the impact of infectious disease and sport on a large scale is a relatively new phenomenon.
Consider, for example, the minimal impact that measles, one of the first described infectious diseases, had on sport. The measles vaccine was licensed and available in 1963, resulting in mass vaccination and greater immunity globally, and only rarely has the disease interfered with sporting events. Only when participating athletes have not been vaccinated has measles posed a problem, such as at the 1991 Special Olympics Games, where 16 athletes were diagnosed with measles after participating at the event in Minneapolis. As vaccination rates have increased, the threat of measles has decreased, making it minimal today.
Other disease outbreaks have, however, caused unanticipated challenges in the past few decades, and emerging diseases, notably those without a vaccine, pose a greater threat to international sporting events. In May 2003, four months before the FIFA Women’s World Cup was to take place in China, FIFA moved the tournament out of China because of SARS, even though none of the venues were in Guangdong province, where SARS first emerged. The decision stemmed from consultations between FIFA’s Sports Medical Committee and the World Health Organization.
The 2014-2015 Ebola virus epidemic, with an estimated fatality rate of approximately 50 percent, also affected sport. Several countries expressed concerns over hosting qualifying matches for the Africa Cup of Nations, the premier soccer tournament on the African continent. Morocco, host of the final tournament, even asked for the event to be postponed for a year, fearing foreign fans would spread the disease. However, the Confederation of African Football refused to postpone the tournament because it did not expect many fans from Ebola-infected countries to travel. They instead expelled Morocco from the tournament.
In 2016, the concern was Zika. While the fear of this disease did scare some travelers and athletes from attending the Olympics in Rio de Janeiro, including the biggest names in golf, WHO focused its attention on recommending that pregnant women or women hoping to become pregnant stay away.
With its rapid spread across the globe and seemingly high fatality rate, averaging 2.3 percent in most cases and about 15 percent in elderly patients, covid-19 has become the fastest-growing health threat that international sport has yet seen.
One of the first sporting events affected by the outbreak, an Olympic qualifying tournament for women’s soccer, was originally scheduled to take place in Wuhan, the epicenter of the viral outbreak. The Asian Football Confederation initially relocated the event to another Chinese city, Nanjing, before moving it again to Sydney.
Sport organizations are holding increasing conversations with local organizers to determine whether events should continue or be canceled. The LPGA Tour canceled its entire women’s Asian swing of three events. The Basketball Africa League has postponed the inaugural season. Some have opted for the Italian solution of proceeding without fans; the CDC suggests practicing such social distancing, meaning it’s not impossible that such remedies may come to American sport.
Health ministries are also getting involved as reported cases of the disease appear close by. During the second weekend of the bobsled and skeleton world championships (Feb. 27-March 1) in Germany, the government of Saxony made all athletes, coaches and media members complete a health survey. The provincial government also recorded the names of every person who attended in case someone ends up infected.
The last time so many international sporting events were canceled was during World War II, and that was because the world was at war. The Ryder Cup, which takes place every other September, was postponed for a year after the 9/11 terrorist attacks, and both MLB and the NFL postponed a week of games as well.
But now, the sporting world is facing a different battle, and approaching unfamiliar territory. With the Olympics just months away, Japanese organizers are holding discussions with the WHO to ensure the mega-event does not lead to a wider spreading of the coronavirus. Tokyo has already shortened the torch relay and has delayed training for its 80,000 volunteers. Yet, an IOC spokesperson insisted Tuesday: “We are going to have the Games on the 24th of July.”
The public health conversation about the 2020 Olympics highlights how sport has become a global institution. The fate of the Games will not be decided by Japanese organizers alone. The IOC and WHO will be involved, and a final decision probably won’t come until May — no matter what the IOC says now. Given the money at stake, the IOC will want to take the interests of sponsors and broadcast partners into account. NBCUniversal has already sold $1.25 billion in commercials for the Games, for example. Although broadcasters would receive some protection from insurance, they and the IOC would still face significant financial losses if the Games are canceled.
This type of conversation may become common in the months and years to come as new emerging infectious diseases pose public health concerns on a global scale. Major League Baseball is consulting with infectious disease specialists to monitor and assess risk daily. While there are no plans for cancellations or disruptions as of yet, looking back at the 1918 Spanish flu pandemic, even healthy athletes are not immune to fatality due to infection.
Until recently, moving a major event, like a world championship, let alone the Olympics, at short notice has simply not been possible with the amount of planning needed. Yet the rapid rate at which covid-19 has spread has demonstrated the need for international sport federations to develop contingency plans for emerging infectious diseases. Not doing so could limit the number of cities willing to risk the financial losses if an event is canceled, as well as jeopardize the health of the public at large through the large crowds at international sporting events, further contributing to the expansion of potential pandemics.