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This article considers the background to, and implications of, the increased diplomatic, economic and strategic interest China is showing in the Pacific Island region. While in recent times this has been linked to political instability in the islands, Chinese contact with the region dates back to the colonial era. In the post-World War Two period Taiwan has competed with China for influence and recognition. The reasons why five island states (Nauru, Tuvalu, the Solomon Islands, the Marshall Islands and Palau) recognise Taiwan are explored. The conclusion reflects on the implications of strains in US-China relations, as well as indications that the region is undergoing a geopolitical transition from American to Asian influence.