Evolving COVID-19 subvariants and waning vaccine-induced immunity: a new public health risk for the African continent

SARS-CoV-2 is not standing still and creates new forms with greater immune-evasion potential that appear threatening to the effectiveness of the protection provided by vaccinations. Though it is demonstrated on the global data that there is a significant degradation of neutralizing antibodies in 4-6 months, the situation in Africa is different since the population is younger, the prevalence of hybrid immunity is high, and adenoviral and inactivated vaccines are more popular in Africa compared to mRNA platforms. The review summarizes the existing knowledge on the declining immunity, breakthrough infections, booster efficacy, and the peculiarities of the epidemiologic and immunologic situation in Africa, and critically discusses the structural factors that influence the response therein one, including inadequate access to vaccines, limited genomic surveillance potential, and vulnerabilities of health systems. The review has not limited itself to identifying the challenges; it has also tried to give solutions in an area-specific way. These involve the adoption of hybrid models of genomic surveillance, combining national high-throughput hubs with the decentralized models of rapid sequencing, developing sustainable mechanisms of funding that lessens the reliance on donor cycles, incorporation of COVID-19 boosters in other established delivery platforms like HIV and malaria chemoprevention and maternal-child health, and specific actions to overcome vaccine-hesitancy (induced by distrust, misinformation, and inconsistent access). To empower the local production, align the data-governance structures, and operationalize the AU-Africa CDC regional collaboration is important in preparing the continent in the future waves of variants and pandemics. Africa's COVID-19 landscape: evolving SARS-CoV-2 variants, waning immunity, and the struggle for equitable vaccination. • Africa's early COVID-19 impact was mild; however, later waves exposed weak health systems and limited preparedness. • The slow and uneven vaccine rollout, along with waning immunity, has left many vulnerable to new variants. • Despite reduced neutralization, vaccines still prevented severe illness, highlighting the need for booster doses. • Inadequate genomic surveillance and misinformation further hinder effective response. • Strengthening vaccination equity, genomic monitoring, and healthcare resilience is essential for future preparedness against such pandemics.