CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

As globalization has pushed health to the forefront of international diplomatic efforts, global

health diplomacy has emerged as a means of neutralizing, managing, and correcting health

threats. Viruses such as the recent novel Coronavirus 2019 (COVID-19), Ebola (Chattu et al.

2020), Zika (Sikka et al. 2016), and Chikungunya have demonstrated that health issues are

not contained/confined to one State, can have detrimental consequences, and require an

immediate response. Well-being and good health, among other things, are essential

components of human existence. This is because man is expected to live a healthy life free of

illnesses and diseases like the COVID-19 pandemic. The COVID-19 pandemic in Nigeria

and the rest of the world also illustrates the importance of collective action in global health as

well, as the infection transcends national boundaries and necessitates governments to

coordinate their response with neighboring States while continuing to serve their respective

population (Taghizade S, 2021).

At a relatively early stage of the pandemic, it was clear that no State was completely

prepared to deal with a shock of such magnitude. Notably, it was wealthier States that

suffered the highest rates of infection and deaths on average in 2020, while many poorer

States were praised for their more effective pandemic response. Indeed, States widely

considered to have the best ‘global health security’ reported the highest numbers of Covid-

related fatalities (Milanovic, 2021).This is puzzling, because a pandemic is precisely the sort

of crisis in which we expect effective state institutions including robust state health systems

to matter. According to Fukuyama (2020), one of the main factors behind successful

pandemic response has been ‘a competent state apparatus’, or more simply, state

1
effectiveness. In a similar vein, Ang (2020) highlights that the capacity of the state to

implement solutions has driven successful pandemic responses. For example, Swiss hospitals

have taken French COVID-19 patients (Swiss Hospitals, 2020). Also, Russia and Cuba have

supported the Italian healthcare system by sending relief packages and the latter one has sent

52 doctors and nurses amidst the COVID-19 crisis (Domenico, 2020). The solidarity brought

hope for States around the globe to restart the relationship under the much-promoted agenda

of Global Health Diplomacy to fight off the pandemic. As the pandemic COVID-19 spread

rapidly not limited to State boundary some States initiated collaborative responses, making it

become easier to handle the situation. For example, at the very beginning of the COVID-19

situation in Wuhan, Taiwan sent a fact finding team to China and collected information as

much as possible. Soon they took preventive steps and became successful to resist severe

destruction (Hsieh & Child, 2020). The strategy of Taiwan is also a prominent case of

responding to COVID-19 crisis. Their collaborative action coordinated policy and quick

response are the core lesson of Global Health Diplomacy perspectives. Fortunately, South

Korea and Germany followed the strategy of Taiwan and Iceland. Soon they were able to

prevent more casualties. Thus, realizing these examples despite several complexities, the

possibility and need of Global Health Diplomacy become more relevant than ever (Vervoort

et al., 2020).

Global Healthy Diplomacy is a concept that widely encapsulates the cooperation of States

towards ensuring the survival of its citizens, especially when faced with the threat of a

pandemic. Since health issues are of utmost importance to States, it has also become a focus

of influence and geo-political strategies of States. This has led to the politicization of diseases

and the need for global health diplomacy. Global Health Diplomacy is central to facilitating

and assuring global prevention, preparedness, and response efforts to imminent health threats

with immediacy and intentionality (Blinken, 2023). Lowering the chances of another global

2
health threat from occurring will require significant diplomacy efforts through a whole-of

government and a whole-of-society approach to strengthen early detection, global pandemic

preparedness, and coordinated response (State.gov., 2021). The emergence of the COVID-19

virus thrust global health diplomacy (GHD) into the spotlight as nations grappled with

unprecedented health crises, economic downturns, and social disruptions. GHD,

characterized by the use of diplomatic tools to negotiate health policies, share resources, and

coordinate international responses, has become crucial in managing pandemics.

Nigeria implemented containment and mitigation measures including travel restrictions and

curfew, social distancing measures, source control measures, self – isolation and quarantine

measures, contact tracing, public health education campaign amongst others in response to

the first wave of COVID-19 and these measures contributed to the mild COVID-19 outcome

in Nigeria compared to the global trend. However, inadequate PCR testing capacity, lack or

suboptimal utilization of epidemic metrics like the virus reproduction number to inform

decision making, and premature easing of lockdown measures among others were major

challenges to the effective implementation of the COVID-19 response measures.

Despite previous research indicating a link between health diplomacy and the COVID-19

pandemic (Omkolthoum, 2020; Caballero, 2020; Brown & Ladwig, 2020), health

diplomacy focuses on global interaction between States with the sole goal of

promoting global health that benefits the entire world. Despite this, there appears to be

little research done in Nigeria’s health context (Abasilim & Moses, 2023), as most

studies have been done in other countries (Rudolf, 2021), most notably in developed

countries such as the United Kingdom (UK), United States (US), China, South

Korea, and some Caribbean countries, or even in some country’s economic sector

(Javed & Chattu, 2020), trade (Chattu, Pooransingh & Allahverdipour, 2021),

international health organizations(Lawrence, Moon & Benjamin, 2020). Furthermore, a

3
review of the literature on the relationship between Health Diplomacy and the COVID-19

pandemic in Nigeria revealed that studies have not focused on the Nigeria Centre for

Disease Control (NCDC) and that Health Diplomacy, as the name implies, lacks

definitional precision, thereby leaving a critical gap that must be filled to determine

whether the findings of previous studies in other climes can be generalized or hold sway in

the Nigerian health context.

Amzat et al (2020) examined the early socio-medical response to COVID-19 in Nigeria in the

first 100 days after the index case in Lagos, South West-Nigeria. The study shows that within

the first 100 days of the first index case of the Covid-19 pandemic in Nigeria, it spread

swiftly. They argued that the government adopted both medical and social responses to

curtail the spread of the covid-19 Pandemic though the responses of the Nigeria government

to the Covid-19 pandemic at its early stage was treated with mix reaction especially as some

Nigerians are yet to come to term with the veracity of the existence of the Covid-19

pandemic, despite the death toll recorded in many developed countries of the world such as

the United States of America, Germany, Britain, France and Canada just to mention a few.

But today, the Nigeria government have intensified more efforts in public awareness

campaign in various mass media platform on the need for them to go for Covid-19 test the

assistance of the Nigeria incidence and Response Tracker and call toll-free hotlines

(https://statehouse.gov.ng/covid19/).

This study seeks to explore and expose insight into how global health diplomatic efforts

influenced global health outcomes, vaccine distribution, and international cooperation and

navigate the intersection of patient rights and the practice of global health diplomacy (GHD),

the role of global health diplomacy during the COVID-19 crisis from 2019 to 2024, shall be

examined.

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1.2 Statement of the Problem
The rapid spread of COVID-19 to every part of the world underscored the need for a swift

and coordinated response to current and emerging health threats. Global Health Diplomacy

(GHD) was a critical tool in navigating the complexities and interconnectedness of the

pandemic and provided the mechanism for a coordinated global response and to secure

equitable access to limited health resources.

However, the pandemic exposed significant gaps in Global Health Diplomacy actors'

knowledge, skills, and competencies, which hindered their ability to effectively respond to a

health crisis of this magnitude despite advancements in global health systems. Not only is

there a critical need to address these gaps as new COVID-19 variants and other infectious

diseases emerge, but there is even greater urgency to ensure global health diplomacy actors

are equipped to effectively navigate and respond to future health challenges as the response to

the COVID-19 pandemic revealed numerous gaps in international collaboration, equity in

resource distribution, and the effectiveness of health diplomacy. There were instances of

vaccine nationalism, inadequate information sharing, and disparities in the global access to

healthcare resources, which underscored the need for a more robust framework for global

health diplomacy.

Global health issues intersect with state' national interests, competing priorities, power

dynamics, and political will. Building consensus among diverse key interest parties (also

known as stakeholders) across multiple sectors, this requires navigating these political

factors, aligning interests, and finding common ground through negotiation. This process can

be complex, challenging, and time-consuming, considering different state and organizations

have varying agendas and global health priorities, often resulting in conflicting viewpoints

(Alegbeleye, & Mohammed, 2020). Balancing competing needs in resource-limited settings,

particularly those characterized by inadequate global health funding, lack of health personnel,

5
and poor health infrastructure, remains challenging.

Strengthening Global Health Diplomacy requires it’s actors to have the necessary knowledge,

skills, and core competencies to navigate the intersection of public health and foreign policy

priorities and build partnerships that foster a collective approach to addressing health threats.

This study seeks to analyses these problems, understand the barriers to effective global health

diplomacy, and propose solutions for future pandemics.

Nigeria, the most populous country in Africa, has had its own unique experience with

COVID-19. The country’s preparedness and response efforts have been shaped by its existing

health infrastructure, governance structures, and international partnership. Nigeria’s response

to COVID-19 has involved a range of measures, including; establishing an incidence

management system to coordinate response efforts, implementing travel restrictions and

screening measures, developing guidance for case management and contact tracing not

forgetting engagement in public awareness.

1.3 Research Questions

This research study seeks to properly investigate global health diplomatic and pandemic

responses, by using the COVID-19 as a case study. The research study seeks to answer the

following questions.

1. How did global health diplomacy impact on COVID-19 response in Nigeria between

2019 and 2024?

2. How did global health diplomacy influence COVID-19 vaccine development in

Nigeria between 2019 and 2024?

1.4 Objectives to the Study

The primary objective of this research is to examine global health diplomacy and pandemic

response on COVID-19 in Nigeria between 2019-2024.

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Specific objectives include:

i. To analyses the impact of Global Health Diplomacy on COVID-19 response in

Nigeria between 2019-2024

ii. To examine the influence of Global Health Diplomacy on COVID-19 vaccine

development in Nigeria between 2019-2024.

1.5 Significance of the Study

The significance of this study, “Global Health Diplomacy and Pandemic Response: A Study

of COVID-19, 2019-2024” has both theoretical and practical implications. In theory,

this paper demonstrates how Global Health Diplomacy (HD) can be accomplished

through collective action. As a result, this paper fills a gap in the literature and

contributes to the academic debate on the expectations of global health diplomacy and

pandemic response in the context of COVID-19 in Nigeria. Previous literature review

reveals that little or no research has been conducted in the Nigerian context, and that global

health diplomacy and COVID-19 lack definitional precision and theoretical

grounding. This paper contributes to the body of knowledge in International

Relations. Furthermore, this paper contributes to the growing body of scholarly

work on Global Health Diplomacy and COVID-19 containment in Nigeria, which

will serve as a guide or reference material for both researchers and public libraries

seeking to understand and conduct similar research and further studies on the subject.

In practice, the study’s findings provide valuable insights to both stakeholders,

international groups and government health workers on how to contain the COVID-19

pandemic through the diplomatic means of Global Health Diplomacy. The study has a

substantial gap in the existing literature by exploring the contemporary implications of global

health diplomacy and pandemic response on COVID-19 in Nigeria between 2019 and 2024.

7
 CHAPTER TWO

LITERATURE REVIEW

This chapter presents the review of related literature under conceptual framework, empirical

studies and gaps in literature.

2.2 Conceptual Framework

This part is structured into parts. The first part will examine the concept of diplomacy with

varying definitions and the concept of global health diplomatic relations. In the second part,

the research work looks at the origin of covid-19 pandemic globally and in Nigeria. In the

third arm, the study will center on government responses to covid-19 pandemic in Nigeria. In

doing so, the study will explore the majors undertaken by Nigeria as well as global health

diplomacy and Nigeria’s national interest.. The fourth part of the study concludes with an

empirical review on the concept of Global Health Diplomacy and gaps in literature.

2.2.1 The concept of Diplomacy

8
The existence of mankind at a reasonable level of civilization is practically impossible

without peace, trade and social relations between nation-states and these things depend upon

diplomacy, upon the representation of states and the adjustments of their contacts. This is

because, according to Adams Smith in his study of International Comparative Advantage,

different nations of the world are endowed differently with different potentials and these

endowed potentials can only be gained and be made possible through the art of diplomacy. In

this way, diplomacy can be defined as “the art of representing states and of conducting

negotiations for a better cooperation for peaceful coexistence among nation states”.

There is no general definition of diplomacy which can be all embracing or consensual.

Consequently, there are as many definitions of diplomacy as there are writers on the concept.
However, as already stated, because of many definitions of the concept diplomacy, there is no
one definition considered to be comprehensive or universal in nature. Sir Earnest Satow
asserts that:

Diplomacy is the application of intelligence and tact to the conduct of

official relations between the governments of independent state,
extending sometimes also to their relations with vassal states; or briefly
still, the conduct of business between states by peaceful means (Satow,
1962:1).

Adams Watson on the other hand believes that:

The diplomatic dialogue is the instrument of international society: a

civilized process based on awareness and respect for other people’s
point of view; and a civilizing one also, because the continuous
exchange of ideas, and the attempt to find mutually acceptable solutions
to conflicts of interests increase that awareness and respect
(Watson:1987: 20).

Some leading diplomats and scholars of international relations have used the word

“diplomacy” to mean the practice of international legal principles and norms in international

relations. In the words of E.J.J Johnson (Johnson: 1964:11)

9
 Although diplomacy might be described as a complex and delicate
instrument that measures forces working at epicentres of international
relations…, the subtle measures of diplomacy can be used to arrest,
ameliorate or reduce, discard misunderstandings and disagreements
which precipitate international crises.

From the different definitions of diplomacy by these authorities, it is therefore

believed that diplomacy is concerned with the management of relations between

independent states and between these states and other actors. Diplomacy is often

thought of as being concerned with peaceful activity, although it may occur within

war or armed conflict or be used in the orchestration of particular acts of violence.

2.2.2 The Concept of Global Health Diplomacy

Global health diplomacy is “an interdisciplinary field that bridges global public health,

international relations, and multisectoral public policy with a goal to achieve “Global health”

(Kickbusch et al., 2021). This description accentuates the World Health Organization’s multi

stakeholder approach to GHD to 1) Improve health security and population health; 2)

Revamp interstate relationships and their commitment to working collaboratively to improve

health; and 3) Alleviate poverty and foster equity through fair and just outcomes (WHO, n.d).

Over the years, the field of Global Health Diplomacy has evolved, predominantly driven by

the fluctuating nature of health security threats (Novotny, 2013).

Global Health diplomacy is defined as global interaction involving a variety of mechanisms

such as the signing of multilateral or bilateral aid agreements between donor countries and

receiving countries to the procedures for developing mandatory as well as non-binding

international health or health-related agreements (Smith & Irwin, 2016). This implies that

health diplomacy entails a healthy interaction between a health facility's sender and receiver,

which is accomplished through a variety of means. Furthermore, according to Ruckert

10
(2016), health diplomacy refers to the processes by which policymakers and non-state actors

attempt to organize measures to promote global health. Health diplomacy is the interaction of

countries regarding health issues that must be addressed.

The concept of global health diplomacy (hereafter known as GHD) has been defined from

different perspectives by many scholars. However, in all these views there is no singular

accepted definition of GHD. However, the central theme in all these definitions is that

negotiation, humanitarianism and projection of foreign policy is at the heart of GHD. To

Novotny and Adams, GHD is the deployment of political relations via the provision of health

care services and through that establishing diplomatic relations. To them the use of health

resources is a tool of fostering diplomacy. It is from this perspective that they defined GHD

as ‘a political change activity that meets the dual goals of improving global health while

maintaining and strengthening international relations abroad, particularly in resource conflict

areas and resource-poor environments’ (Lee and Smith 2011).

The role of health diplomats has also evolved to include the dual responsibility of managing

countries’ interdependence while representing national and communal interests (Sending,

Pouliot & Neumann, 2011). Diplomacy among States remains critical, warranting that

bilateral and multilateral partnerships developed over the past 200 years are leveraged to

manage ongoing changes to the global health landscape (Mahbubani, 2022). These duties

recognized the need for negotiating binding trade and economic agreements within the health

and environmental sectors (ITC, 2023). Thus, emerging and existing global health threats,

multilevel interactions, the diversity in GHD actors, and changes to the rules, norms, and

expectations account for the state of flux of Global Health Diplomacy (Kickbusch & Ivanova,

2013).

2.3 The Origin of COVID-19 Pandemic Globally and in Nigeria

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A pandemic is a worldwide outbreak of infectious disease that occurs simultaneously

in one or more countries or across one or more continents (Honigsbaum, 2009). It is an

outbreak that affects a large number of people and spreads globally or across a large

region, that is, it crosses international borders (Qiu., Rutherford., Mao & Chu, 2017).

The word “pandemic” comes from the Greek words “pan” and “demos,” which mean

“everything” and “people,” correspondingly. Pandemics are disease outbreaks caused by

direct contact between people (WHO, 2011). Throughout history, many major disease

outbreaks and pandemics have occurred, including the Hong Kong Flu, Spanish Flu,

SARS, H7N9, Zika, and Ebola (Rewar, Mirdha & Rewar, 2016).

On January 7, 2020, the first case of the virus was confirmed in China and the virus was said

to have originated from a popular seafood market in Wuhan, China, which according to the

victims, they have either visited or worked at. This deadly disease is characterized by fever,

coughing, and shortness of breath (Chauhan, Jaggi & Yallapu, 2021). The World Health

Organization (WHO) deemed the outbreak a pandemic on March 11, 2020 (Dhama, Patel,

Sharun, Pathak, Tiwari, Yatoo, & Rodriguez, 2020). Before it reached human-to-human

transmission, it was initially believed that the virus was transmitted from animal to human

(Guo, Cao, Hong, Tan, Chen, Jin, and Yan, 2020). Olapoju (2020) gave a brief but

comprehensive overview of coronavirus pandemic in Nigeria. By February 27, 2020, Nigeria

recorded its first confirmed case of COVID-19, which was a 44-year-old Italian Citizen who

had arrived in Murtala Mohammed International Airport, Lagos, Nigeria at about 10 pm on

February 24, 2020, via a Turkish airline from Milan Italy. He subsequently travelled to his

company site in Ogun State on February 25, 2020. On 26 th February of same the year, he

presented at the staff clinic in Ogun State and there was a high index of suspicion by the

managing physician. He was referred to Infectious Disease Hospital (IDH) Lagos and

COVID-19 was confirmed on 27th February.10 This observation placed Nigeria second on the

12
line of inception of the COVID-19 incident case, second to Algeria that reported her index

case on February 25, 2020. The initial cases were mostly with overseas origin. On 8 th March,

2020, one of the asymptomatic contacts to the record case in Ogun was affirmed to have

tested positive to the virus.

On 17th March 2020, a 30-year- old Nigerian female was diagnosed of COVID-19 in Lagos.

She got back from the United Kingdom on the thirteenth of March. On the eighteenth of

March 2020, five new affirmed instances of COVID-19 was recorded in Nigeria, carrying the

record to 8 cases. All the new five cases had a movement history to the UK or USA: four

were recognized in Lagos while one distinguished in Ekiti had contact with an explorer from

the USA. On the nineteenth of March, 2020, four new affirmed instances of COVID-19 were

recorded in Nigeria carrying the recorded cases to twelve affirmed cases. All the four new

cases were from Lagos. One has a travel history to the UK: one to France, 3 rd case was a

contact to one of the previously confirmed cases; 4 th case had no history of travel but lived

with foreigners/expatriates. These record continued increasing in number and by the end of

March, there were 151 cases and four deaths. As at the time of writing over a total of 5000

COVID-19 tests have been conducted and there have been 373 total confirmed cases,

11 deaths and 99 discharged. The latest available updates from the NCDC situation

report(45)showed details of the cases’ provenance as travel history –144 (47%), contacts –

88 (29%), unknown source –6 (2%), and incomplete –67 (22%). Males 221 (72%) are

more affected than females 84 (28%). The COVID-19 cases in Nigeria (40). The NCDC data

in the public domain shows that over 50% of those who reported that they had symptoms of

the COVID-19 were imported cases.

13
 COVID-19 pandemic in Nigeria

Disease COVID-19

Virus strain SARS CoV-2

Location Nigeria

First outbreak Wuhan, Hubei, China

Index case China

Arrival date 27th February, 2020 (5

years, 2 months, 2 weeks

14
 and 2 days ago)

Confirmed cases 267,188

Recovered 207,254

Deaths 3,155

Fatality rate 1.18%

Vaccinations 93,829,430 (total

vaccinated)81,297,810

(fully

vaccinated)133,048,024

(doses administered

Government website

Source; Covid-19.ncdc.gov.ng

2.4 Government Responses to COVID-19 Pandemic in Nigeria

The outbreak of the contagious COVID-19 pandemic is a shocking example of unimaginable

misinformation about how deadly an illness is, when, where, and how to obtain a vaccine

against the virus. Following China's first confirmed cases of COVID-19, Nigeria was one of

the first countries to identify the potential danger and began preparations (Anjorin, 2020).

Though Nigeria has been dealing with the emergency effect of the lockdown, which forced

governments to provide relief packages to communities hardest hit by the virus, these

15
palliatives were politicized for no discernible reason during the first wave of the pandemic in

Nigeria (Buss & Tobar, 2018; Ebenso & Otu, 2020). To decrease the virus's spread, Niger

government embarked on a variety of non-pharmaceutical procedures, such as travel

restrictions and curfews, social distancing measures, source control measures, self isolation

and quarantine measures, social isolation, contact tracing, public enlightenment campaign etc

and also included clinical intervention and implementation .

2.4.1 Travel restrictions and curfew

Travel restrictions into Nigeria were announced on March 18, 2020; 3 weeks after the first

index case. This allowed enough time for the importation of the virus into the country, as

returnees from abroad comprised the majority of those who tested positive for the virus (The

Punch 2020a). Inter-state lockdown was first placed on three states with high incidence on

March 29, and then on April 23, 2020, all the 36 states in the country and the FCT were

placed on inter-state travel restriction, that is, 57 days after the index case was confirmed

(The Punch 2020b). This response by the Nigeria’s government in imposing lockdown after 8

weeks was rather slow compared to countries like South Korea and Germany (Balmford et al.

2020), and this may have undermined conventional global COVID-19 prevention strategies

and also indirectly aided community spread of the virus in the ensuing months in the country

(Flaxman et al. 2020). Moreover, there is evidence that countries such as Germany and South

Korea that imposed lockdown measures early on following the index cases or even before the

index cases, were able to flatten the curve while countries such as the United States of

America and the United Kingdom that did not introduce the lockdown measures early on

witnessed virus exponential growth (Balmford et al. 2020). Although dusk-to-dawn curfew

was enforced, the daily socio-economic activities of the citizens may have largely invalidated

16
the impact the curfew was supposed to have on curtailing the spread of the virus by breaking

the transmission chain (Ibrahim et al. 2020).

Nevertheless, the gradual ease of travel restriction/lockdown, first on May 4, 2020, than on

June 6, 2020, was in disregard to World Health Organization guideline on ease of lockdown.

As at the time when the lockdown measures began to be eased; the number of new infections

was higher than number of recoveries, there was never 14-day fall in new infections and there

was no evidence that showed that COVID-19 transmission is controlled, nor was the

reproduction number less than 1 at any time in the country and in all the states (WHO 2020).

Therefore, the ease of lockdown may have been majorly influenced by economic

considerations and not out of regard for evidence-based epidemiological data. NCDC, the

Nigeria’s public health authority argued that the ease of the lockdown measures at a time

when COVID-19 cases was on the increase was a tradeoff aimed at balancing the public

health concerns with the devastating economic consequences of the lockdown on Nigerians

especially the most vulnerable including women, internally displaced persons, poor

individuals, small and medium business enterprises among others (Dan-Nwafor et al. 2020).

2.4.2 Social distancing measures

Social distancing is a strategy aimed at reducing physical contact between people, so as to

reduce the risk and spread of COVID-19 in a community. This measure meant that, at least,

two meters in physical distance must be maintained between two individuals. Moreso,

physical greetings-hugs and handshakes were to be avoided (NCDC 2020c). In order to

enforce this, the federal government of Nigeria prohibited large gatherings, issued

compulsory stay-at-home directives to non-essential public servants, and also shut down

schools, markets, and churches (NCDC 2020c). Not surprisingly, compliance with these

directives was resisted by majority of the populace. In a country where the survival of over

17
85% of its population rely on their daily economic activities, even the meager palliatives

given by the government could only reach about 2% of the population (Actionaid 2020), the

bulk of the remaining 98% would inevitably starve to death if they were to abide by the social

distancing measures. Faced with the grim choice of exposure to COVID-19 virus or hunger,

most Nigerians choose to ignore social distancing measures in pursuit of their livelihood.

This measure which failed in its enforcement may have sustained the transmission chain of

the virus in states with high-density population such as Lagos, Oyo, Plateau, and FCT that

recorded increased incidence of the virus.

2.4.3 Source control measures

Measures taken in anticipatory bid to reduce likelihood of disease spread or prevent infected

individuals from spreading disease are referred to as source control. These include but are not

restricted to wearing face masks, hand hygiene, and respiratory hygiene (NCDC 2020d;

MDH 2020). The NCDC advocated for the use of proper handwashing with soap and water,

use of alcohol-based sanitizer, and respiratory hygiene when coughing or sneezing (NCDC

2020d). However, the use of face mask only received late attention after recommendation by

Presidential Task Force (PTF) on April 27, 2020, a move that was then followed by the

NCDC in May 4, 2020 (Abubakar et al. 2021), despite that there was scientific evidence from

China, South-East Asia, and Europe as early as February/March 2020 that demonstrated the

potency of face masks in reducing the spread of the virus (PAHO 2020). The NCDC decision

on the use of face masks about 9 weeks after the first index case was rather improvident and

may have further fueled the virus spread in the country.

2.4.4 Self-isolation and quarantine measures

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Self-isolation, defined by the NCDC to mean staying at home or in an identified

accommodation, away from situations where one can mix with family members or the

general public, for a period of 14 days, was also adopted as part of the measures to combat

the virus. All returning travelers to Nigeria, anyone who had contact with a confirmed case,

and COVID-19 patients who had just been discharged from the hospital were expected to

self-isolate (NCDC 2020e). As is the case with South Africa, it is unclear how the quarantine

process is being implemented as people self-isolate in homes (Moodley et al. 2020). Thus, the

compliance level is difficult to estimate. This also means that the impact of this measure on

Nigeria’s first wave COVID-19 response is inconclusive, but is however still subject to

further investigation. However, it is important to note that prior to the ban on international

travel, international passengers arriving at Nigerian international airports were allowed to

self-quarantine for 14 days without testing and supervision by the Nigerian public health

authority. Consequently, multiple undetected cases of COVID-19 may have been imported

into Nigeria between January 2020 to March 18, 2020 (Dan-Nwafor et al. 2020). Expectedly

NCDC with the introduction of travel ban migrated to obligatory supervised quarantine for all

arriving passengers at Nigerian international airports and borders (Dan-Nwafor et al. 2020).

2.4.5 Contact tracing

As of October 17, 2020, 34,901 were persons of interest in contact tracing, out of which

97.4% (33,994) have been traced. This is not so remarkable a feat because about 73%

(44,483) of 56,557 confirmed cases were due to unknown source of exposure (NCDC 2020a).

A likely explanation for this is that sustained community transmission of the virus has been

ongoing prior to individuals testing positive for the virus. Moreover, the absence of a robust

national health database in Nigeria means that contact tracing had to be done manually,

which is rather slow and rely on the patient’s ability to recall. Furthermore, no attempt has

19
been made in scaling up to a faster and more efficient digital tracing which seemed very

effective when used in Taiwan (Wang et al. 2020b).

2.4.6 Provision of palliatives and stimulus packages

As part if government efforts towards encouraging the citizens to comply with the sit-at-

home order and to cushion the harsh effects of COVID-19 economic realities, the federal and

state governments made concerted efforts to provide palliative care in the form of good items,

hand sanitizers, face masks and other basic social needs ( NCDC, 2020a, b, c). The Federal

Government of Nigeria expanded it’s social safety net, with welfare programmes in it’s

efforts to reduce poverty and to mitigate the unintentional impacts of the partial lockdown on

the livelihood of the poor and vulnerable households in affected states. These provisions

included food rations, food vouchers, conditional cash transfers, and other forms of

palliatives targeted vat the vulnerable and socially disadvantaged members of the society

(Human Rights Watch, 2020). In Ondo State, the governor of the state disclosed that more

than 200,000 households have benefitted from palliative distribution since the outbreak of

COVID-19 (Johnson, 2020). In May, 2020, Oyo State Government, the World Bank, and

Heritage Bank PLC have distributed palliative packaged to more than 200 less- privileged

individuals in the state; the distribution end in September 2020 ( Badru, 2020).

2.4.7 Diagnosis and testing

The testing strategy in the current pandemic adopted by Nigeria has been the priority-based

testing, where only individuals who show certain symptoms and, or have had contacts with

any of the index cases, are tested for COVID-19. As of November 29, 2020, data from the

NCDC showed that 776,768 tests had been carried out using the Reverse Transcriptase

Polymerase Chain Reaction (RT-PCR) testing method. The absence of community testing

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capacity in Nigeria means that only a small fraction of the population was tested. In this same

period, Nigeria (NCDC 2020a) conducted 3,865 tests per million of her population, which is

very low in comparison with Ghana (GHS 2020) and Rwanda (RCS 2020) which had

conducted at least 19,758 and 49,601 tests respectively, per million of their Population

(World Bank 2020). This may be due to lack of rapid diagnostic kits, scarcity of reagents, and

poor coordination among the 75 government diagnostic laboratories in the country (NCDC

2020g; Onyeaghala and Olajide 2020). The actual number of people infected is unknown, as

seemingly healthy individuals were not tested unless they had travel history to high-index

countries within a period range. Consequently, we suggest that the number of infected people,

although asymptomatic, could have been more in Nigeria. Indeed, serological survey in

October 2020 in four states in Nigeria detected antibodies to SARS-CoV-2 in 9–23% of

individuals tested (Ihekweazu and Salako 2021). Thus COVID-19 cases, mortality,

morbidity, and recovery may be grossly underestimated.

2.5 Nigeria’s Involvement in Global Health

Despite several decades of warnings of global pandemic threats and contingency planning,

the Nigeria and the rest of the world were largely unprepared for the COVID-19 pandemic

(Frutos, Gavotte, Serra-Cobo, Chen, & Devaux, 2021). “The COVID 19 pandemic laid bare

these failures in global and Nigerian domestic preparedness and implementation, exposing

important lessons that had not been learned, critical initiatives left unfunded, and solemn

obligations that had not been met” (Bollyky & Patrick, 2020). One key lesson from the

pandemic is the importance of preparedness anchored in robust surveillance, early warning,

and early detection systems for rapid and inclusive deployments and response

Nigeria has demonstrated its vested interest in global health for over a century by actively

engaging in international health activities. Concurrently, Nigeria also contributes to foreign

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policy priorities, national security concerns, and broader development goals. These efforts

and more are realized through a Whole-of-Government approach that leverages multiple

Nigeria Government agencies and departments, and funding committees. Nigeria’s

multifaceted role in global health includes providing financial, health-related, and

development assistance, program operations, health service delivery, emergency and disaster

responses, strategic partnering with bilateral, multilateral, and private sector actors, and

global health diplomacy. Nigeria’s global health efforts are implemented mainly through

agencies and departments within the Executive branch of government.

The experiences in Nigeria demonstrated that limited integration of donor-funded vertical

programs with government systems jeopardizes the sustainability of these programs and

complicates the use of program resources to support emergency responses to outbreaks.

However, close partnerships with government agencies and good field collaboration

improved the overall response. The effectiveness of global health initiatives will very likely

be improved through better coordination between donor-supported programs and

government-led systems and institutions for establishing initiative priorities, design,

implementation, and evaluation. Specifically, investments through global health initiatives

should be reviewed in the context of government-led systems and institutions. Individual

initiatives should align with approaches for other endemic diseases, even if those diseases are

not priorities of donor partners. Such an approach has the potential to provide an even higher

level of return on investment for donors (Binder 2021).

Nigeria’s Presidential Task Force for COVID-19 provides an example of a government-led

structure supported by donors during an emergency. The growth and increasing capacity of

the National Public Health Institutes in Africa supported by the Africa Centers for Disease

Control provide an opportunity for improved convergence and coordination.

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Investments in global health programs should be leveraged to improve preparedness for

future pandemics. Several reports have shown that countries with higher investments in

health security were better prepared to respond to the COVID-19 pandemic. Previous

investments in preparedness coordinated by NCDC, such as the establishment of a public

health EOC network and digitalization of the country’s surveillance system, provided a

foundation for Nigeria’s COVID-19 response. Subsequent funding for HIV, tuberculosis,

malaria, and polio programs should enable appropriate responses to future pandemics.

Investments could potentially include the development of common standards that increase

flexibility to use these funds in response to large outbreaks and pandemics, while ensuring

continuity of program specific goals. Our

experience during the COVID-19 pandemic showed that pooling and unified governance of

resources from various donors reduced fragmentation and increased the collective response to

the pandemic. Initiatives such as the United Nations Basket Fund and the private sector task

force Coalition Against COVID-19 enabled government leadership to direct resources toward

interventions that maximized pandemic responses while providing donors with opportunities

to contribute their diverse expertise and maintain financial oversight. Using such approaches

in future global health interventions, especially in large countries, could reduce the risk for

fragmentation.

In conclusion, strong collaborations among partners that have governments at their core will

prevent or mitigate the effects of the next pandemic. The World Health Organization Hub for

Pandemic and Epidemic Intelligence was established in response to this urgent collaborative

need. For example, the Hub for Pandemic and Epidemic Intelligence has begun to develop a

set of principles to support data sharing across countries and disciplines. Developing and

sustaining a global health security architecture enshrined in the principles of mutual trust and

equity for all is not only necessary but is a critical approach to mitigate the next pandemic.

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2.6 Global Health Diplomacy and Nigeria’s National Interest

Global health diplomacy is crucial for Nigeria’s national interest, offering opportunities for

citizen welfare, economic growth, regional stability, national security, global leadership,

economic and social development and promotion of human rights. By harnessing its strengths

and addressing the challenges, Nigeria can play a more active and influential role in global

health, benefiting both its citizens and the wider international community.

Citizen welfare: Global health initiatives, like disease eradication campaigns and access to

essential medicines, directly benefit Nigeria’s population. Health diplomacy can facilitate

access to funding, technologies, and expertise to improve Nigeria’s healthcare system and

address health disparities. Economic Growth: A healthy population is a productive

population. Investing in global health can boost economic growth in Nigeria by reducing

healthcare costs, increasing productivity, and attracting foreign investment. Healthy

populations also contribute to a more stable and secure environment, which is conducive to

economic development. Regional Stability: Nigeria’s role in regional health initiatives,

particularly within the Economic Community of West African States (ECOWAS), can

contribute to greater regional peace and stability. Addressing transboundary health threats,

like infectious diseases, strengthens regional cooperation and reduces potential security risks.

National Security: Global health diplomacy can enhance Nigeria’s national security by

addressing threats like pandemics and infectious diseases. By participating in global health

initiatives, Nigeria can build partnerships, share information, and develop capacity to respond

to health emergencies effectively. Global Leadership: Nigeria can use its position to

advocate for its interests within global health organizations and initiatives. This can involve

pushing for policies that promote equitable access to healthcare, support research and

development of health technologies, and address issues like climate change, which impacts

health. Economic and Social Development: Addressing health issues like maternal and child

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health, nutrition, and access to healthcare services, can contribute to overall social and

economic development in Nigeria. These improvements can lead to increased productivity,

reduced poverty, and improved living standards. Promotion of Human Rights: Global

health diplomacy can be used to promote and protect human rights, including the right to

health. This can involve working with international organizations to ensure access to

healthcare for marginalized communities and advocating for policies that protect the health of

vulnerable populations.

2.6.1 Barriers to Global Health Diplomacy and Pandemic Response

Global Health Diplomacy efforts were tested when the world was faced with a public health

pandemic. The GHD response to COVID-19 mitigation efforts demonstrated in real time the

need for a cohesive, coordinated global response to address the pandemic. Strengthening

Global Health Diplomacy requires GHD actors to have the necessary knowledge, skills, and

core competencies to navigate the intersection of public health and foreign policy priorities

and build partnerships that foster a collective approach to addressing health threats. These

responsibilities require the four Cs of emergency or disaster planning and response:

collaboration, communication, coordination, and cooperation (Martin, Nolte, & Vitolo, 2016;

Nkengasong, 2023). The COVID-19 pandemic exposed significant gaps in Global Health

Diplomacy (GHD) actors’ knowledge, skills, and competencies, which hindered their ability

to respond effectively to a health crisis of this magnitude. Some of these barriers includes:

Lack of international coordination: The months leading up to and those following the

WHO’s declaration of COVID-19 as a Public Health Emergency of international concern

revealed the lack of global cooperation and coordination (Jones & Hameiri, 2022). Every

State appeared to have varying pandemic preparedness uncoordinated response levels, and

variable approaches to engaging a public health response. These differences resulted in the

implementation of isolated prevention and mitigation strategies such as restrictions on trade

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and travel, stay-at-home orders, social distancing measures, and mask mandates (Sirleaf &

Clark, 2021). The lack of coordination hampered efforts to manage the crisis. Political

tensions and conflicts: the existing rivalry and political tensions between nations hindered

real-time information and resource sharing (Dhami et al., 2022). These factors are critical to

Global Health Diplomacy practice and promoting a collective pandemic response and a joint

response to any other global health emergency. Vaccine equity and access: The pandemic

underscored stark inequities in the availability, affordability, and access to vaccines that

persist to this day. The disparities in equitable vaccine distribution amongst countries,

particularly between high-income and low- and middle-income countries (LMICs),

manifested as vaccine nationalism. Vaccine nationalism is “an economic strategy to hoard

vaccinations from manufacturers and increase supply in their own country” (Riaz et al.,

2021). In the race to manufacture and purchase COVID-19 vaccines, many developed States

prioritized the needs of their citizens through a ‘my country first’ or ‘every nation for itself’

approach over global solidarity, putting more people at risk (Guterres, 2021). The health and

well-being of people from LMICs who lacked the technology, expertise, and ability to

develop their own vaccines were similarly neglected in the COVID-19 vaccine response.

Wealthier States’ decisions to roll out COVID-19 boosters, while many low-income States

were yet to secure the first round of single-dose vaccines, sparked significant controversy.

Research data from 152 countries estimates that over a million lives may have been lost in

LMICs due to wealthier nations hoarding COVID-19 vaccines (Ledford, 2022).

Misinformation and miscommunication: Furthermore, the spread of disinformation and

misinformation during the pandemic is arguably one of the most significant obstacles to

Global Health Diplomacy (Tagliabue, Galassi, & Mariani, 2020). Uncertainties about the

virus’s nature, effects, virulence, and allegations about its origins served as fodder for false

information, undermining trust among nations. Mis-and-disinformation campaigns, rumors,

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and conspiracy theories eroded the public’s trust in public health authorities and global health

institutions (Lewandowsky, Linden, & Norman, 2024), making implementing effective

public health measures difficult. The speed at which the COVID-19 vaccines were developed

also contributed to global vaccine skepticism and hesitancy, expressed as people’s reluctance

or unwillingness to get vaccinated (Wiysonge et al., 2021). These factors resulted in a lack of

cooperation among countries and reluctance to share accurate data, making coordinating the

international response even more challenging. Economic constraints: Insufficient funding

for pandemic prevention, preparedness, and response remains a global challenge despite the

recent history of epidemics and infectious disease outbreaks. The economic impact of the

pandemic also affected Global Health Diplomacy actors’ efforts to elicit dedicated funding

for the pandemic response. Many countries grappled with the challenge of allocating

resources for international assistance while simultaneously addressing the growing demands

of their own citizens and the needs of their health systems (Kaye et al., 2021). Geopolitical

rivalries: The pandemic exacerbated existing geopolitical rivalry and power struggles and

highlighted significant issues plaguing multilateral systems over the past decade. The

geopolitical impasse and heightened tensions in diplomatic relations between the United

States and China were particularly glaring, underscored by the lack of trust and information

sharing about the origin of the virus (Zhou, 2024).

2.7 Empirical Review: significant empirical studies from previous research work

considered to be relevant to this present study is reviewed as follow:

The relationship between health diplomacy and the COVID-19 containment has undoubtedly

piqued researchers' interest. The majority of studies yielded a variety of outcomes; for

example, Javed and Chattu (2020) discovered that COVID-19 is still spreading around the

world and has claimed lives, highlighting the failure of international cooperation. They also

believe that health should not be used as a political tool at the expense of people's lives or as

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a proxy for geopolitics, but rather to reduce tensions and foster a conducive environment for

political debate. Similarly, Caballero (2020) asserts that preventing the COVID-19 pandemic

from having disastrous consequences requires a coordinated and efficient global response

involving all actors at various governmental levels.

However, this study backs up Caballero's (2020) initial observation that a coordinated

determination is required to mitigate the consequences of the COVID-19 pandemic. Soft

power has been shown to be extremely effective in achieving national objectives and

interests. Because of this success, more countries have increased their efforts in both

directions of health diplomacy. Subarkah and Bukhari (2020) explain the need for global

steps such as the World Economic Forum acting as a liaison between the government,

business, and the private sector to create a COVID-19 Response Action Platform in South

Korean Health Diplomacy in the face of COVID-19. According to Chattu and Chami (2020),

SDGs 10 and 17 are concerned with reduced inequalities and partnership for the goal, while

SDG-16 is concerned with peace, justice, and strong institutions, implying that global health

diplomacy serves as a complex wheel that engages with these parameters.

They also suggested that there is a strong need for all key stakeholders to collaborate in a

multi-pronged approach through global health diplomacy to mitigate, avoid, and combat such

health security threats (both now and in the future). In contrast to the preceding studies,

Brown and Ladwig (2020) asserted that, unlike the World Trade Organization, the WHO has

no authority to sanction or otherwise pressure its member states to do things against their

will. In addition to what Brown and Ladwig (2020) observed, the failure of the World Health

Organization and individual countries to stop COVID-19 is explained by the World Health

Organization and individual countries' lack of obligatory, institutional, and epistemic power.

Similarly, Gauttam, Singh, and Kaur (2020) discuss how inadequate healthcare services in

28
developing countries have been discovered. Dhimal, Ghimire, Pokhrel, and Dhimal (2021)

proposed that an equitable allocation of COVID-19 vaccines be based on global health equity

and social justice principles to reduce existing health and socioeconomic disparities between

developed and poor countries in order to avoid inequalities between countries. According to

Ching, Chien, and Chuan (2020) Taiwan's combat experience with COVID-19 offers an

alternative model to China's myth of authoritarian efficacy. They went on to say that the

country's ability to respond quickly has improved as a result of health diplomacy, which has

resulted in international cooperation from other governments, regional and international

organizations.

Another study, conducted by Javed and Chattu (2020), has transformed the foreign policy-

health nexus. In a similar vein, Fazal (2020) contended that health diplomacy differs from

health governance in that governments' goals in engaging in health diplomacy may not be

focused on regulating the global policy environment for health. Similarly, Barrinha and

Renard (2020) stated in their study that numerous challenges lie ahead, and regional

reengagement will take time. Similarly, Divsallar and Narbone (2020) discovered that the

issues caused by COVID-19 could pave the way for new approaches to resolving US-Iran

tensions. Many will be determined, however, by the strategic decisions made by both parties.

While Gostin, Moon & Meier (2020) found in their study that a new governance environment

will be critical to enhancing global public health as it emerges from crisis and secures a safer

future.

According to E-International Relations and Al Bayaa (2020), developing more sophisticated

bilateral health data apparatuses among nations, establishing long-term data collaborations

among governments, increasing the number of Health Attachés globally, and substantiating

global health policies through post-modern health diplomacy will all help to find new

solutions to future health challenges. Taghizade, Chattu, Jaafaripooyan & Kevany (2021)

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argued in their study that the post coronavirus world could be characterised by increasing

nationalism conflicts over economic resurgence and political dominance. Strengthening

collaboration among nations at various levels, on the other hand, will result in increased

health, economic prosperity, and security. Likewise, Jatmika, Permana, Koko, and Salsabila

(2021) thought that the Indonesian government had significant issues with political

communication with communities, international intergovernmental organisations, and

individuals and health diplomacy.

According to Sharma, Casanova, Corvin, and Hoare (2021), public health and global health

practitioners must learn health diplomacy skills to function well in complex health crises like

the present coronavirus disease (COVID-19) outbreak. Similarly, Chattu, Pooransingh and

Allahverdipour's study from 2021 channelled opinions on the value of commerce and

economic principles while concluding that achieving this goal requires concerted action. In

this multipolar international society, it is crucial to go forward collaboratively to ensure a

safer world. COVID 19 has presented both challenges and opportunities. The Rudolf (2021)

study, which found it plausible to anticipate China to play a significant role in immunizing

the world's population, may also be connected. This would support the Chinese leadership's

portrayal of China as a significant responsible power. Since the start of the pandemic, China

has made the Belt and Road Initiative (BRI), a high-profile initiative of President Xi Jinping's

foreign policy, a condition of its support in the fight against the virus.

2.8 Gaps in Literature

Global Health Diplomacy is central to facilitating and assuring global prevention,

preparedness, and response efforts to imminent health threats with immediacy and

intentionality. Thus, lowering the chances of another global health threat from occurring will

require significant diplomacy efforts through a whole-of government and a whole-of-society

30
approach to strengthen early detection, global pandemic preparedness, and coordinated

response (Adisasmito, et’al 2022).

The covid-19 pandemic has highlighted the critical importance of global health diplomacy

thus this research study will help to draw theoretical understanding of global health and its

role in pandemic response. The research study’s findings will have practical implications for

policymakers, diplomats and global health professionals from critical lessons learned from

the recent pandemic and how these can inform the training and development of present-day

and future Global Health Diplomacy actors to deliver on their mission of preventing,

preparing for, and responding to current and future health security threats. According to

Kickbusch et al., “ensuring that diplomats have a combination of different skills increases the

professionalism of global health diplomacy negotiations and the likelihood of achieving

successful outcomes.” Developing these skills builds the capacity of current and future GHD

professionals, and practicing them in real-life scenarios like the World Health Assembly

(WHA) is increasingly being recognized as a critical component of their training.

CHAPTER THREE

METHODOLOGY

This chapter contains the following: theoretical framework, applicability of the theory,

hypotheses, research design, method of data collection and method of data analysis.

3.1 Theoretical Framework

This study is anchored on constructivism theory, The theory was propounded by Nicholas

Onuf in his book “World of our Making. Rules and Rule in Social Theory and

International Relations.” Constructivism is a theory that argues that the behavior of states

and international actors is shaped not only by material interests but also by ideological

factors. This perspective suggest that states are merely motivated by power and self-interest;

31
they are also influenced by their beliefs, values, and perceptions of the world (Cho 2015).

The constructivism approach to international relations emphasizes the role of ideas, norms,

and identities in shaping state behavior and international interactions. In the context of global

health diplomacy, this approach highlights the importance of shared understandings,

collaborative problem solving, and adaptive governance in addressing health crises like

COVID-19.

The Core Components of Constructivism are:

Social construction of Global Health including pandemics like COVID-19, are socially

constructed through interactions among states, international organizations, and non-state

actors. These constructions influence how health issues are prioritized, framed and addressed.

Secondly, international norms and standards for global health governance shapes state

behavior and International Corporation. These norms can facilitate or hinder effective

response to health crises.

Also, identity and interest formation: State identities and interest are shaped by domestic and

international factors, including cultural, economic and historical contexts. These identities

and interest influence how states engage in global health diplomacy.

Lastly, collaborative problem solving: Effective global health diplomacy requires

collaborative problem solving among diverse actors, including states, international

organizations, and non – state actors. This collaboration can facilitate shared understandings,

mutual interests, and adaptive governance.

3.1.2 Application of the Theory

In the context of the study of global health diplomacy and pandemic response, the COVID-19

pandemic highlights the importance of effective global health governance, including

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international corporation, information sharing,, and adaptive governance. Nigeria’s identity

as a regional leader in West Africa and its interest in economic development and human

security shape its engagement in global health diplomacy.

Secondly, international norms and standards for global health governance, such as the

International Health Regulation (IHR), influence Nigeria’s response to COVID-19.

Furthermore, Nigeria’s response to COVID-19 requires collaborative problem-solving among

diverse actors, including the government, international organizations, and non-state actors.

Effective global health diplomacy requires a shared understanding of global health issues and

collaborative problem solving among diverse actors. This helps to provide a constructivist

approach to understanding global health diplomacy and COVID-19 response in Nigeria,

highlighting the importance of shared understandings, collaborative problem-solving, and

adaptive governance in addressing health crises.

3.2 Hypotheses

Based on the theoretical framework and the background of the study, the following

hypotheses will guide the research:

1. Global health diplomacy negatively impacted on COVID-19 response in Nigeria

between 2019 and 2024 as a result of health security interests of advanced states.

2. Global health diplomacy undermined COVID-19 vaccine development in Nigeria

between 2019 and 2024 due to economic dominance interest of advanced states.

These hypotheses will be tested through empirical analysis, allowing for a deeper

understanding of global health diplomacy and pandemic response on COVID-19 in Nigeria.

3.3 Research Design

This study adopted an ex-post facto research design. Ex-post facto research design, as

33
elucidated by various scholars, is characterized by its observational nature, wherein the

researcher investigates the impacts of independent variables that were not manipulated by the

researcher but rather occurred naturally or were pre-existing conditions (Sekaran & Bougie,

2016). This design allows for the examination of causal relationships between variables in

real-world settings, providing valuable insights into phenomena that cannot be ethically or

practically manipulated in controlled experiments (Leedy & Ormrod, 2014). Additionally, it

enables researchers to explore relationships between variables retrospectively, making it

particularly useful for studying historical events or phenomena with existing data (Gay, Mills,

& Airasian, 2011). Thus, the adoption of an ex-post facto research design aligns with the

study's objectives and facilitates a nuanced understanding of the effects of independent

variables on the research outcomes.

3.4 Method of Data Collection

The study made use of documentary method of data collection as the source of data

collection. Documentary data collection is the systematic investigation and analysis of

existing documents or records. It involves finding and analyzing things that people have

written. It is a method of collection of data through the use of personal or official documents

like newspaper, journals, articles, books, tapes, computer files, directories, and online

resources relevant to the topic of Global Heath Diplomacy and pandemic response: A study

of COVID- 19 as the source of information. The source of data collection in this present

research involves the use of books, journals and Newspapers. Journals have gradually

become more important when data collection for research is concerned. This is because

journals are updated regularly with new publications on a periodic basis, therefore giving to

date information. Again, journals are usually more specific when it comes to research. Also,

the information passed through a newspaper is usually very reliable. Hence, making it one of

the most authentic sources of collecting secondary data. The kind of data commonly shared in

34
newspapers is usually more political, economic, and educational therefore it is considered

situated as a secondary source of data collection in this research. By leveraging these diverse

secondary sources, the study aimed to construct a comprehensive understanding of the

challenges, opportunities, and outcomes of implementing Global Heath Diplomacy and

COVID-19 pandemic response particularly focusing on Nigeria from 2019-2024.

3.5 Method of Data Analysis

Data analysis plays a crucial role in research as it allows researchers to uncover valuable

insights, identify patterns, and draw meaningful conclusions from the collected data. In this

study, content analysis will be utilized as the method of data analysis to critically evaluate the

information gathered from the diverse range of secondary sources listed above. Content

analysis involves systematically examining and interpreting the content of textual or visual

data to identify themes, patterns, and trends (Krippendorff, 2018). It provides a structured

approach to analyzing qualitative data, allowing researchers to categorize, code, and analyze

the content of the sources in a rigorous and systematic manner. To conduct content analysis

for this study, the researcher will begin by carefully reviewing the collected secondary

sources, including journal articles, official reports, textbooks, newspapers, magazines,

archival records, and online materials. Each source will be scrutinized to extract relevant

information related to Global Heath Diplomacy and COVID-19 pandemic response

particularly focusing on Nigeria from 2019-2024.

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