Recent scholarship suggests that in areas featuring entrenched poverty and compromised state infrastructures, disease outbreaks prompt multinational interventions that often supplant state institutions in the provision of health services. Ethnographic observation of a multinational avian influenza project in Vietnam permits exploration of the ways in which “global health” operates in a Communist state characterized by an active governmental apparatus. Descriptions of the routine activities of one veterinary cadre illustrate the practical actions through which the Vietnamese state exerts influence over global health processes. In the daily work of bird flu management, global health cadres negotiate an inconstant divide between multinational health agendas and established practices of state-making. The analysis thus begins the crucial task of addressing the ways in which global health interventions operate in nations that, while vulnerable to public health emergencies, are nevertheless characterized by growing economies and influential state apparatuses.