The dwindling list of countries to officially recognise Taiwan shrunk again last week when Nauru abruptly severed diplomatic ties in favour of China.
Some Pacific watchers have questioned whether Beijing could look to persuade Tuvalu into making a similar switch.
Incumbent Prime Minister Kausea Natano is widely regarded as a friend of Taiwan, but his finance minister Seve Paeniu has floated the idea of reviewing ties.
Another leading contender, Enele Sopoaga, a former prime minister, has voiced concern about a recent security treaty with Australia.
There are only a little over 6,000 registered voters in the country of around 11,500 people.
Polls have already closed and results are expected later on Friday.
However, there is uncertainty as to which of the 16 elected MPs will then be chosen as premier.
With no formal political parties, the process of MPs selecting a prime minister and government policies could be slow.
Taiwanese ambassador to Tuvalu Andrew Lin recently dismissed the idea of a potential switch, telling AFP the two allies enjoyed a "very long-term friendship" that would endure beyond the election.
But China has been methodically poaching Taiwan's Pacific allies, convincing Solomon Islands and Kiribati to switch recognition in 2019 before Nauru did the same.
Senior Tuvalu diplomat Bikenibeu Paeniu recently told The Australian newspaper there were "rumours" his nation could "follow suit".
Tuvalu, a tiny nation of thinly populated atolls and reef islands, is one of only 12 remaining states, including the Holy See, that fully recognise Taiwan.
It is among the world's most vulnerable nations due to rising sea levels.
China claims democratic, self-ruled Taiwan as part of its territory and has vowed to one day seize it.
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