This paper provides a broad survey of existing literature on contemporary solid waste management (SWM) in the Pacific region to underscore an urgent and compelling need for improved SWM. Despite advances in waste management systems and funding for technical support and capacity building from a range of sources, waste continues to threaten public and ecological health and the economy in Pacific Islands Countries and Territories (PICTs). SWM in the Pacific requires innovative thinking in a challenging environment of remoteness, limited available land, fragile ecosystems, vulnerability to natural hazards and subsequent climate sensitivity. Many PICTs are under considerable pressure to open their markets up to trade liberalisation. Increasing links to the global economy through trade liberalisation could either further exacerbate waste management challenges in the Pacific or contribute to environmental protection and sustainable development goals. The authors argue that if the PICTs' urgent waste management challenges are to be meaningfully addressed, the region's leaders must ensure trading partners conform to local environmental protection policies and that trade agreements align with sustainable development goals.