TAIPEI, Taiwan — The United States’ top health official lauded Taiwan’s democracy on Monday as he met with the island’s leader for a visit laden with symbols of stronger ties between Washington and the self-ruled island claimed by Beijing.
Alex M. Azar II, the secretary of health, is the highest ranking American official to visit Taiwan since Washington severed official ties with the island in 1979 and established formal diplomatic relations with the Communist government in Beijing. Mr. Azar landed on Sunday at Songshan Airport, in downtown Taipei, and was met by Brent Christensen, the de facto ambassador, and Taiwanese officials.
Mr. Azar’s trip should have been unremarkable — a visit by an American health secretary to an unofficial ally in Asia that has been among the few success stories of the coronavirus pandemic. But with relations between the United States and China in a downward spiral, Mr. Azar’s trip has taken on greater significance. His visit points to the increasingly important role Taiwan will play — and the risks the island will face — in a brewing ideological battle between the world’s two largest economies.
“It is a true honor to be here to convey a message of strong support and friendship from President Trump to Taiwan,” Mr. Azar said in remarks at the Taiwanese presidential office before heading into a meeting with Tsai Ing-wen, the island’s leader. “Taiwan’s response to Covid-19 has been among the most successful in the world, and that is a tribute to the open, transparent, democratic nature of Taiwan’s society and culture.”
Taiwan has welcomed Mr. Azar’s visit as a chance to strengthen relations with the United States, its most powerful military backer, and to showcase its widely praised response to the virus, which it achieved despite efforts by China to diplomatically isolate the island.
As of Monday, the island of 23 million off the southeastern coast of China had reported just 480 coronavirus cases and 7 deaths. Taiwan’s officials have sought to build on that success to promote the island as a model of democracy, in part by sending millions of masks labeled “Made in Taiwan” to countries in need.
“Over the last few months, Taiwan and the U.S. have worked together to confront the challenge posed by the Covid-19 pandemic,” Ms. Tsai said in remarks welcoming Mr. Azar. The two officials wore blue surgical masks as they met.
“When the people of Taiwan saw footage of White House officials wearing ‘Made in Taiwan’ masks, they were happy that these products were helping people in partner countries,” she said.
Mr. Azar’s visit brings to the fore a perennial source of friction between the United States and China. China’s ruling Communist Party claims Taiwan as its own and objects to official exchanges with the self-governed island. China’s leader Xi Jinping has said that Taiwan is the most important issue in relations with the United States and has vowed to annex the territory by force if necessary.
But talk of a new Cold War has intensified as tensions between the Trump administration and Beijing have surged over geopolitics, human rights, trade and technology. As the election in the United States approaches, the Trump administration has taken an increasingly gloves-off approach to dealing with China’s authoritarian government, opening new fronts in the confrontation nearly every week. In the past month, there have been fresh clashes over consulates, journalists’ visas and Chinese social networking apps.
Mr. Azar’s trip is being billed as an opportunity to strengthen economic and public health cooperation between Washington and Taipei and to tout democratic governance as the best model for protecting public health. His visit is in keeping with a practice dating back to the Clinton administration of dispatching senior American officials in economic or technical posts to the island. The last cabinet-level visit to Taiwan was a 2014 trip by Gina McCarthy, then-administrator of the Environmental Protection Agency.
To critics of the Trump administration, the timing and highly publicized nature of Mr. Azar’s visit reflects the government’s desire to distract from its own failed response to the virus. The United States passed a grim milestone over the weekend, with 5 million known cases — the most of any country — and more than 161,000 deaths from the coronavirus, according to a New York Times database.
The visit is also a test of China’s tolerance of the United States’ support for Taiwan at the most volatile time in the relationship between Beijing and Washington in decades. Both powers have in recent months stepped up their military presence in the region, fueling concerns about the growing risk of a confrontation, whether intended or not.
Beijing has vowed to take countermeasures for Mr. Azar’s visit to Taiwan. China has already lodged a formal complaint with Washington and urged it not to “gravely damage” relations.
Some experts, however, say China could choose to adopt a relatively restrained response because the United States has previously sent cabinet-level officials to visit Taiwan. There are also concerns that further provocations could push Mr. Trump into taking more actions on Taiwan.
“The Chinese side — the whole world — is speculating that Trump could make some even more severe adventures in his China policy to save his prospect of re-election,” including by breaching China’s “very serious bottom line over Taiwan,” said Shi Yinhong, a professor of international relations at Renmin University in Beijing.
The decision to send Mr. Azar comes amid growing frustration in Washington over what is seen as China’s outsized influence on the United States’ relationship with Taiwan, now one of the most vibrant and prosperous democracies in East Asia.
No sitting Taiwanese president has been allowed to visit Washington, and ties between the United States and Taiwan are managed through quasi-official institutions like the American Institute in Taiwan which issues visas and provides other basic consular services.
“A lot of what the U.S. does with Taiwan has been so restricted based on Chinese reactions,” said Jessica Drun, a nonresident fellow at the Project 2049 Institute, a nongovernmental organization in Virginia that studies security and policy issues in Asia. “We have become oversensitized to China’s reactions and they’re aware of this.”
There are doubts about Mr. Trump’s personal commitment to Taiwan. Recently, John R. Bolton, Mr. Trump’s former national security adviser, wrote in his memoir that the president had repeatedly disparaged the island’s significance, comparing Taiwan to the “tip of one of his Sharpies.”
Publicly, Mr. Trump and his administration have been far more supportive. In 2016, the then president-elect broke with nearly four decades of diplomatic practice when he accepted a congratulatory phone call from Taiwan’s president Tsai Ing-wen.
In 2018, Mr. Trump, over China’s objections, signed the Taiwan Travel Act, which encouraged high-level official visits between the two sides, paving the way for Mr. Azar’s visit. The United States remains the island’s top arms supplier, and the administration has approved additional weapons sales to Taiwan.
Chan Chang-chuan, a professor of public health at National Taiwan University, said that one area in which Americans could boost their support for Taiwan was in coronavirus-related therapeutics. The United States and China are currently among the countries leading the race to develop a vaccine.
“I do have a very strong wish that Secretary Azar can listen to what we really need,” Mr. Chan said. “If we get nothing and China has a vaccine, then it would be like if we didn’t have good weapons to defend our security. It’s strategic.”