Health Diplomacy, COVAX Vaccine Access, and Pandemic Governance Lessons from Ebonyi State

The COVID-19 pandemic exposed profound inequities in global health governance, particularly in the distribution of vaccines between high-income and low-income countries. Nigeria's participation in the COVAX Facility, a multilateral vaccine access mechanism, generated significant diplomatic and public health debates about equity, sovereignty, and the effectiveness of international health cooperation. Ebonyi State's pandemic response, characterized by a combination of federal vaccine allocations and locally improvised containment strategies, offers a subnational lens through which to examine how global health diplomacy translated into practice at the community level. This study analyzes the implementation of COVAX vaccine distribution in Ebonyi State between 2021 and 2023, evaluating logistics, uptake rates, and governance challenges. A qualitative methodology is employed, combining document review of state vaccination reports and COVAX program data with interviews of health officials, community mobilizers, and civil society representatives. Health systems theory and global health governance literature frame the inquiry. Findings reveal significant logistical bottlenecks in cold chain infrastructure, compounded by vaccine hesitancy driven by misinformation circulating through social media networks in Ebonyi communities. State-level coordination between the Ministry of Health and international health partners was uneven, reflecting broader gaps in Nigeria's subnational health diplomacy infrastructure. The study concludes that future pandemic preparedness diplomacy must explicitly incorporate subnational capacity building and culturally tailored communication strategies as non-negotiable program components. Keywords: health diplomacy, COVAX, pandemic governance, Ebonyi State, vaccine access