Morocco's fight against measles began in the 1980s with nationwide vaccination campaigns that significantly reduced cases during the 1990s and early 2000s. However, recent increases in cases, driven by declining vaccination rates, have raised concerns. An unexpected surge in measles cases has been affecting Morocco over the past couple of years. Since September 2023, 25,000 measles cases have been recorded in the Kingdom, with 120 deaths attributed to the contagious disease, according to health officials. On December 30, 2024, Minister of Health and Social Protection Amine Tahraoui reported that infections represented 52.2 cases per 100,000 inhabitants, with a fatality rate of 0.55%. Children under 12 years old accounted for almost half of these deaths. Virologists attribute this measles outbreak in Morocco to vaccination issues. Since the Covid-19 health crisis, a global trend of increasing vaccine hesitancy has led to a decline in vaccination coverage rates in most regions and provinces of the Kingdom. A battle against measles since the 1980s Morocco's battle against measles, one of the most contagious human diseases caused by the Measles Virus (MeV), began decades ago. The country first introduced the measles vaccine in 1981. By 1982 and 1983, the number of recorded measles cases stood at 63,180 and 80,806, respectively. However, by 1984, this number had dropped significantly to an impressive 11,484. According to a May 2014 study published in the European Scientific Journal titled «Progress Towards Measles Elimination in Morocco», the number of measles cases declined from 120,000 annually before the vaccine's introduction to 4,216 in 1985. However, this decline lasted only three years. In 1987, an increase of 26,621 measles cases was reported. In response, the Moroccan government launched the National Immunization Days that same year, aiming to expand vaccination coverage. These efforts raised national vaccination coverage from 73% in 1987 to over 93% by 1996. In 1997, Morocco took another significant step by joining the World Health Organization's Eastern Mediterranean Regional Office (WHO/EMRO) program to eliminate measles in the region. The country focused on improving vaccination coverage for the single-dose vaccine administered at 9 months of age. However, according to the same study, this one-dose vaccination strategy, maintained for 23 years, allowed measles to remain an endemic disease in Morocco, with epidemic cycles occurring every 4 to 5 years. A second dose in 2003 Between 1996 and 2003, the number of reported measles cases in Morocco ranged from 1,324 to 11,000 annually, with the highest incidence among children aged 5 to 9 years. Despite this slight surge, health officials in Morocco responded to WHO recommendations by introducing a second dose of the measles vaccine in 2003, targeting all children at school entry (6 years old). This intervention significantly reduced the number of reported measles cases, with figures dropping to 6,511 in 2004, 2,212 in 2005, and 1,217 in 2006. However, by 2007, measles cases began to rise again, reaching 2,248. The same study notes that this year marked a turning point. Before September 2008, measles outbreaks in Morocco were linked to imported virus strains, such as D7, B3.2, and later D8. These strains became endemic by 2007 and 2008, as the large number of unvaccinated individuals allowed the virus to continue spreading. Mass vaccination in 2008, 2013 In response, Morocco launched a massive vaccination campaign in May-June 2008, using the Measles-Rubella (MR) vaccine. The campaign targeted over 3.5 million children aged 9 months to 14 years, focusing on reaching remote and underserved communities. Children who had already received a second vaccine dose between 2003 and 2008 were excluded from this campaign. The 2008 campaign achieved highly satisfactory coverage rates of 96% and 100% for age groups 5-59 months and 5-14 years, respectively. Five years later, Morocco organized another mass vaccination campaign in 2013, targeting children aged 9 months to 19 years. According to a study titled Measles in «Morocco: Epidemiological Profile and Impact of Vaccination Strategy», this campaign led to a significant decline in reported measles cases. By 2013, only 92 cases were reported, slightly increasing to 96 in 2014. Resurgence Despite these efforts, measles continues to persist. Morocco achieved a low incidence of less than 1 case per 1 million people, with vaccination coverage exceeding 95%. However, since 2020, the country has witnessed a rise in measles cases. This resurgence coincides with a global outbreak affecting several regions, particularly Europe, Africa, and the United States. In 2024, the Moroccan Health Ministry identified a concerning drop in vaccination rates in some urban areas, contributing to the virus's spread. In January 2025, the Ministry of Health emphasized strengthening coordination and vigilance at the local level among relevant departments to combat the spread of measles. An updated version of the Epidemic Surveillance and Response Manual states that in Morocco «all regions, provinces, and prefectures are now affected and must take appropriate action».
