Almost 20 years ago, measles was declared eliminated from the United States. This meant that measles was not circulating in the general population. Only small, random outbreaks were to be expected from time to time as someone would travel abroad and introduce measles to a population that is not immunized enough to prevent an outbreak.

Measles, a highly contagious respiratory viral disease, was brought under control through the use of the MMR (measles, mumps and rubella) vaccine. As more and more children were immunized, there were less and less susceptible people for the virus to grow and multiply. Some experts even predicted that measles would be eradicated from the planet much in the same way that smallpox was eradicated in the 1970s.

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For an infectious disease to be eradicated, several things need to happen. First, humans must be the only reservoir of the germ that causes the disease. Second, the vaccine against it must be highly effective. Third, enough people must be willing to be immunized for community immunity to protect those who cannot be immunized due to medical reasons. Finally, the vaccine needs to be readily accessible to all.

As it turns out, measles fit three of these four criteria; measles is only found in humans and the MMR vaccine is highly effective. Those who receive one dose have a 93 percent chance of not acquiring the disease if they are exposed. With a second dose, that effectiveness increases to 97 percent.

In the United States, government programs have made vaccines accessible to almost every single person in the country. Yet here we are in 2019 with the highest number of measles cases in the country since the mid-1990s. Why? Because not enough people were willing to be immunized.

There is no “typical” vaccine-hesitant person. Their level of education, wealth and social standing varies. They are also culturally and ethnically diverse. Some even have degrees that one would think would prevent them from denying the science. Then there are those who are not necessarily vaccine-hesitant: They see a chance at making money by tricking people into buying a service or product.

This lack of a typical profile of a vaccine-hesitant person is what makes it so difficult to address vaccine hesitancy. What works for one group may not work for another. In an era of social media conspiracy theories, how do you convince the conspiracy theorist that a coordinated campaign by the government is not a conspiracy?

When everyone has access to a wealth of scientific education online, but few do it in a formal way that guarantees they have learned the science clearly, how do you convince that “citizen scientist” that their science is a gross misunderstanding of very complex subjects? And, in a country where we value individual liberty and use the word “socialism” as a slur, how do we convince a person that they must take on the infinitesimally small risk of a vaccine reaction in order to benefit everyone around them?

Needless to say, we in public health have our work cut out for us. We need to figure out how to communicate with all of those segments of the population. Furthermore, we need to prevent the next generation of vaccine-hesitant parents. To do this, we are making more and more of the information about vaccines — its science and history — freely available to the public and verified by trusted sources. We are engaging vaccine-hesitant people on social media, answering their questions and listening to their concerns. We are also making science, technology, engineering and mathematics (STEM) more attractive to younger and younger minds since those four disciplines are the core of vaccine research, design and manufacturing.

Perhaps the most difficult fight we have ahead of us is in politics. Because of the nature of our government, laws regarding immunization are political. Part of our efforts to increase immunization uptake include navigating the political seas.

For conservatives, we remind them of George Washington’s use of variolation against smallpox to win the Revolutionary War, or how Thomas Jefferson and Benjamin Franklin advocated for the use of variolation.

They did so with the knowledge that some of those variolated would suffer and die from smallpox, but the larger population would be protected. (Variolation involved intentional infection of smallpox under controlled and medically supervised conditions. It is not done anymore because we have safe and effective vaccination).

For the more liberal vaccine-hesitant people, we need to remind them that there is no medical procedure more “leftist” than vaccination. It is intended to be given to the greatest number of people in order to protect the most vulnerable among us.

It is a form of government regulation of disease, one that demands of all of us an equal amount of risk — albeit a very, very small one — in order to benefit all of us equally. For both conservatives and liberals, we need to remind them that our inalienable rights come with inescapable responsibility, like the responsibility to not carry infectious diseases and comply with medical recommendations to stop outbreaks.

The Centers for Disease Control and Prevention just announced that the cases of measles in the United States have topped 800 this year, a number not seen in a generation; and we’re only in the fifth month of the year.

In the United States, the main reason for the resurgence of measles is the refusal to comply with vaccine mandates and recommendations from small-yet-vocal groups. This affects us all because there are plenty of people who cannot be vaccinated due to a medical condition, and we all have to pay in terms of money and resources to contain these epidemics.

Using a combination of skills and techniques, public health workers will fight back against these diseases now before worse vaccine-preventable diseases return, before the most vulnerable among us are affected on a grand scale. Time will tell if we get to eradicate measles, polio and other similar diseases, along with scientific illiteracy and denialism.

René Najera, MPH, DrPH, holds a degree in medical technology from the University of Texas at El Paso, a Master of Public Health degree from the George Washington University and a Doctor of Public Health degree from the Johns Hopkins University Bloomberg School of Public Health. He is an associate in the epidemiology department at the Bloomberg School and the editor of the History of Vaccines online project by the College of Physicians of Philadelphia.