The Trump administration’s Alex Azar meets Taiwanese president Tsai Ing-Wen in Taipei: EPA

The Trump administration’s increasingly belligerent China policy has taken another turn with Alex Azar’s visit to Taiwan – the first such engagement by a top-level US official since the 1970s.

At a meeting with president Tsai Ing-wen on Monday, the health and human services secretary heaped praise on the democratic island country, which China considers a breakaway province.

“Taiwan’s response to Covid-19 has been among the most successful in the world,” Mr Azar told his host, “and that is a tribute to the open, transparent, democratic nature of Taiwan’s society and culture.”

Driving home the point of the visit, the secretary said the visit “represents an acknowledgement of the United States and Taiwan’s deep friendship and partnership across security, economics, health care, and democratic open transparent values”.

And for her part, Ms Tsai described the visit as “a huge step forward in anti-pandemic collaborations between our countries”.

China’s response to the visit has been unequivocal. In an unusual move just before the meeting, it sent fighter planes on an incursion into Taiwanese airspace, in range of the country’s anti-aircraft missiles; they were driven out by Taiwanese aircraft.

Later that day, Chinese foreign ministry spokesperson Zhao Lijian made plain the Chinese Communist Party’s feelings. “I would like to stress again that the Taiwan issue is the most important and sensitive issue in China-US relations,” he said. “What the US has done seriously violated its commitment on the Taiwan issue.”

Washington broke off official diplomatic ties with Taipei in 1979, and since then has mostly observed cordial relations with the government in Beijing. And while Donald Trump himself repeatedly railed against China during his first presidential campaign, his complaints at that point revolved mainly around what he described as China’s unfair trade practices and its undercutting of American manufacturers.

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However, many Trump administration officials have from the off displayed a far cooler attitude to China than some of their predecessors, and Mr Azar’s visit is just the latest part of a sharp acceleration in the US’s hawkish turn. In the years since, this has developed into a broader agenda of grievances.

Most recently, the administration’s animosity has cohered around certain key issues: the coronavirus, which Mr Trump has accused China of lying about or even creating in a lab; the Chinese Communist Party’s domestic enforcement policies, specifically its crackdown in Hong Kong and its treatment of the Uighur minority in Xinjiang province; and the security risks posed by Chinese technology companies, in particular Huawei, which the US has lobbied other Western countries to lock out of their high-tech infrastructure projects.

These are all layered on top of longer-running disputes with China that have not developed into outright conflict, but which have put a strain on the relationship as Beijing puts pressure on American allies.

High up the list is the South China Sea, which China has spent the last decade asserting its claim over despite multiple international legal decisions to the contrary.

The Philippines, Vietnam, Indonesia and Japan, among others, have all been obliged to respond to China’s installation of military bases in the area, including in their territorial waters, with the US sending aircraft carriers to assert its determination to resist the Chinese claim – and China in turn continuing military drills and base construction.

These encounters often escalate one way or another when general diplomatic tensions are high. And sure enough, in the run-up to Mr Azar’s visit, satellite images emerged showing Chinese amphibious armoured vehicles assembling near the South China Sea – and specifically, at the Taiwan Strait.

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