Photo/Illutration U.S. Health and Human Services Secretary Alex Azar, left, is greeted by Taiwanese Foreign Minister Joseph Wu prior to their meeting in Taipei, on Aug. 11. (AP Photo)

TAIPEI--Taiwan sent COVID-19 assistance to foreign countries surreptitiously to avoid protests from China, its foreign minister said Tuesday during a meeting with the highest-level American official to visit the island in four decades.

China claims Taiwan as its own territory and has sought to isolate it diplomatically, including barring its participation in forums such as the World Health Assembly.

The trip by U.S. Health and Human Services Secretary Alex Azar comes against the backdrop of a sharp downturn in relations between China and the United States and Azar said in his remarks that the United States supported Taiwan’s participation in international health forums.

China’s attempts to isolated Taiwan has compelled the island at times to keep its donations of masks and personal protective equipment under the radar, Foreign Minister Joseph Wu said.

“Truth is, we even had to deliver these supplies quietly in some occasions to keep the recipients free from trouble, trouble from Beijing,” Wu said.

Taiwan has brought its virus outbreak under control, and Wu said the island has donated 51 million masks overseas, including 10 million to the United States, along with other items of personal protective equipment. He did not name the other countries to which Taiwan has made quiet donations or give other details.

Just 15 countries maintain formal diplomatic ties with Taiwan, and China has sought to peel away its remaining allies.

Wu said Chinese pressure to accept political conditions for bringing Taiwan under Beijing’s control has made life “increasingly difficult.”

However, acquiescence would merely turn Taiwan into another Hong Kong, Wu said, referring to recent arrests of media figures and pro-democracy activists under a new national security law being enforced in the semiautonomous Chinese territory.

“We know this is not just about Taiwan’s status, but about sustaining democracy in the face of authoritarian aggression,” Wu said.

Azar described “political bullying” over Taiwan’s exclusion from the World Health Organization in 2018 that blocked a million-dollar Taiwanese contribution that would have helped combat an Ebola outbreak in Congo.

“Especially during a pandemic, but at all times, international organizations should not be places to play politics,” Azar said.

While the United States maintains only unofficial ties with Taiwan in deference to Beijing, it remains the island’s most important ally and provider of defensive arms. A 2018 U.S. law urged Washington to send increasingly high-level officials to Taiwan in contrast to past years when such visits were extremely rare. Thus, Azar is the highest-level American official to visit Taiwan since their break in formal diplomatic ties in 1979.

Relations between China and the United States have deteriorated over issues ranging from the South China Sea to TikTok, Hong Kong and trade. In a throwback to the Cold War, the two recently ordered tit-for-tat closures of consulates in Houston and Chengdu and rhetorical sniping has become a daily occurrence.

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