Unless you have been intentionally avoiding the news for at least a year (understandable), you know that measles is making a comeback.

Pre-vaccination, more than 90% of children in the United States developed measles, and there were approximately 500,000 cases each year. While most recovered, the death rate of approximately 1 in 1,000 led to about 500 dead kids each year. That began to change with licensure of a measles vaccine in 1963, which led to a plummeting of cases in the following years, such that in 1978 the Centers for Disease Control and Prevention proposed measles elimination in the U.S. 

Remarkably, that goal was achieved. In 2000, measles was declared eliminated, which has a technical definition of the absence of endemic measles transmission in a region for greater than 12 months in the presence of a well-performing surveillance system. That is to say, a few sporadic cases can occur and the disease is still considered eliminated if it is not spreading in the country. There was even hope that actual elimination could occur — that we could follow the example of smallpox and actually eliminate the disease from the earth.

Related: Share of Minnesota kindergartners exempt from measles vaccine has nearly doubled in past 10 years

This hope was reinforced in 2010 when rinderpest became the second viral disease to be eradicated. The rinderpest example was particularly relevant, because this disease, a scourge of cattle herds until it’s elimination, is closely related to measles. Recent research has shown that the two viruses diverged about 2,600 years ago, an incredibly short time in viral evolution, meaning they are extremely similar. 

Unfortunately, the rinderpest model was not followed with measles. Vaccination rates for measles have dropped, including in places like Minnesota that used to have measles vaccination rates hovering at the 95% level needed to avoid outbreaks. Now, we are at 87%, and falling. Directly related: last year was the worst year for measles in the U.S. in three decades, with at least 2,280 cases and three deaths.

Why does this matter? I’ve been asked that by friends, who shake their heads at the increasing anti-vaccine sentiment, and then mention that they’re glad they and their kids are vaccinated. The bad news is that vaccination is not perfect. Having two doses of the Measles-Mumps-Rubella (MMR) vaccine confers 97% protection from measles, but 97% is not 100%. Think of your MMR series as some exceptionally effective (but not perfect) body armor. When there’s a rare bullet whizzing by, it’s extremely unlikely that it will find the 3% of you that is vulnerable. But when you are facing a hail of bullets, the chance that one finds that weak area becomes much higher.

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As we enter 2026, it’s increasingly likely that you will encounter measles. A current outbreak in South Carolina is spreading, and there are increasing numbers of unvaccinated kids to help it spread even further. This is not helped by the fact that current federal policy is minimizing the benefits of vaccination, promoting non-evidence-based treatments like cod-liver oil and antibiotics, and dismantling the progress made since 1963.

These efforts are fueling the anti-vaccine sentiment that has existed for centuries, and make it probable that 2026 will surpass 2025 as the worst year for measles in three decades; the 910 reported cases as of Feb. 13 put us 40% of the way to 2025’s 2,280, with 10.5 months to go. So why are the cows safe from rinderpest while we are watching measles explode? Simple. Vaccines work. And there are no anti-vaccine cows.

Dr. Dimitri Drekonja is an infectious disease specialist and professor of medicine at the University of Minnesota.

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