Island nations are a unique ecosystem often isolated geographically. This isolation can be an advantage but also a limitation. While their remote locations provide a buffer against the initial spread of disease, this same isolation also creates logistical issues of access to medical supplies, healthcare support, and vaccines in times of emergencies. Heavy dependence on tourism created economic vulnerability for island nations and territories during border closures in response to the COVID-19 pandemic. The COVID-19 pandemic posed unique challenges for island nations, highlighting both their geographic advantages and systemic vulnerabilities. This chapter will explore the COVID-19 responses in island nations, evaluate some of the challenges encountered, and the unique responses to the pandemic. The lessons learned and response strategies as well as propose recommendations for future preparedness.