A trip by the US health secretary to a country that has successfully contained coronavirus would not normally be controversial — unless that country is Taiwan, which China claims as its territory.

Alex Azar, who landed in Taiwan on Sunday night, is the most senior US cabinet official to visit the island since Washington broke off diplomatic relations with Taipei in 1979.

The visit highlights the strengthening of ties between Taiwan and the US, its unofficial protector, as well as the new risks it creates for Taipei as it becomes a crucial battleground in the escalating clash between the world’s two biggest economies.

“We ought to push the envelope because the envelope was sealed by us, and we have opened it before,” said William Stanton, a former director of the American Institute in Taiwan, the US’s quasi-embassy in Taipei. “But there is the worry — and it is one Taiwan needs to consider as well — that the China threat is consistently there.”

Under commitments made to Beijing as part of its switch in diplomatic relations from Taiwan to the People’s Republic of China 41 years ago, Washington has long avoided any semblance of official ties in its dealings with Taipei. It has a set of internal rules stipulating that communication between government officials must go through AIT, that Taiwan’s government must only ever be referred to as “authorities” and that administration officials must not meet representatives of Taiwan in US government offices.

But as the political establishment — and public opinion — in the US has turned against China, pressure has built for better treatment of a fellow democracy.

Under Donald Trump, the US has deepened its engagement through a flurry of co-operation initiatives, ranging from cyber security to gender issues, more substantive military contacts and higher profile bilateral government exchanges.

Since late 2017 the US president has signed six laws aimed at supporting Taiwan, including streamlining arms sales, encouraging high-level visits, and helping Taiwan preserve its remaining diplomatic allies and gain greater participation in international organisations.

At the same time, adherence to Washington’s strict internal protocol guidelines has started to fray — an issue regarded as highly politically sensitive to the Chinese government, which abhors any sign that Taiwan might gain recognition.

Two weeks ago, for example, David Stilwell, assistant secretary of state, received Taiwan’s new envoy to the US at the state department, a departure from protocol as prescribed under the department’s internal rules.

Senior US officials including Mike Pompeo, secretary of state, and Matt Pottinger, deputy national security adviser, have also set a new tone. They have made high-profile statements in which they praised Taiwan, called it a force for good in the world, and referred to Tsai Ing-wen, the country’s top elected official, by her title of president. 

One recent pro-Taiwan law even called Taiwan a country.

However, despite elation in the Taiwanese government about what officials on both sides have called the best relations in decades, observers are wary.

“There are people in the administration who want to improve relations with Taiwan because they believe Taiwan is a strong advocate for American values and a good friend to the US,” said Shelley Rigger, a professor at Davidson College in North Carolina and a leading Taiwan expert.

But she added: “Others want to upgrade relations with Taiwan as a way of tweaking Beijing and showing that the US is not afraid to challenge Beijing.”

Analysts said the US had made many substantive changes but it had not taken Taiwan’s economic interests into account. The administration has failed to seriously consider a bilateral trade agreement which could help mitigate Taiwan’s exclusion from other regional trade deals due to Chinese pressure.

Washington’s efforts at cutting off Chinese technology group Huawei from key chip suppliers and disintegrating global supply chains has also squeezed Taiwan, home to TSMC, the world’s largest contract chipmaker.

Most important, observers are concerned that Mr Trump — who has described Taiwan as insignificant by comparing it to the tip of his pen — could use the country as a pawn in his fight against China.

Prof Rigger said the president’s erratic foreign policy record — including his abandonment of the Kurds in Syria and his flip-flopping in his dealings with North Korea — might suggest to Beijing that he could back down in the face of serious risk.

“If I were Beijing I would be asking myself: ‘If the US gives us a justification to attack Taiwan, what are the odds that he will change his pattern of cutting and running?’” she said. “Is Donald Trump really going to go to war with China three months before the election — over a pen nib?”

Key dates in shifting US-Taiwan relations

1972

US president Richard Nixon visits China. In the Shanghai Communique, the US “acknowledges that all Chinese on either side of the Taiwan Strait maintain there is but one China and that Taiwan is a part of China”. In two subsequent documents signed in 1979 and 1982, Washington inks diplomatic ties with Beijing and says it would gradually reduce arms sales to Taiwan if the situation was peaceful.

1978

US State Department issues internal Taiwan Guidelines stipulating Taiwan must no longer be referred to as Republic of China and its government not be called a government.

1979

US switches diplomatic relations from Taipei to Beijing and passes the Taiwan Relations Act, committing the US to help Taiwan defend itself.

1982

Ronald Reagan gives Taiwan six assurances, committing the US to not: agree a date to end arms sales; mediate between Taiwan and China; pressure Taiwan into negotiating with China; change its position on Taiwan sovereignty; plan to revise the Taiwan Relations Act; agree to consult Beijing before selling arms to Taiwan.

1996

US send aircraft carriers into the Taiwan Strait after China fires missiles into the sea north and south of the island ahead of Taiwan’s first direct presidential election.

2002

Taiwan Justice Minister Chen Ding-nan becomes the first Taiwan official to be received in the White House after 1979.

2016

US president-elect Donald Trump takes congratulatory phone call from Taiwan president Tsai Ing-wen, the first such direct communication since 1979.

2017

The 2018 National Defense Authorization Act normalises the process of arms sales to Taiwan after the Obama Administration bundled them to avoid political fallout from China.

2018

• The 2019 National Defense Authorization Act requests assessment of Taiwan’s military capabilities, recommendations for strengthening its forces and more security co-operation, including joint exercises.

• The Asia Reassurance Initiative Act confirms US support for close relations with Taiwan. It also calls for the US to counter Chinese moves to change the status quo.

2019

The 2020 National Defense Authorization Act calls for more co-operation with Taiwan on cyber security.

2020

• The Taiwan Allies International Protection and Enhancement Initiative Act (TAIPEI Act) commits the US government to advocating more participation for Taiwan in international bodies and supporting Taiwan in strengthening ties with its remaining diplomatic allies.

• Alex Azar, US health secretary, goes to Taiwan, the highest profile American official to visit the island since Washington switched diplomatic relations from Taipei to Beijing in 1979.