Health pandemics have specific and severe impacts on the lives of women and girls. Since the COVID-19 outbreak first had reported cases, the gendered impacts began being documented in the Pacific and across the world. Women and girls are disproportionately impacted by crises. Existing gender inequalities are exacerbated during a crisis, with the result that women and girls face even higher rates of violence, sexual abuse and control from their husbands, partners and families. Women are expected to undertake more unpaid domestic work, are less able to access essential health services and are more vulnerable to economic hardship. Crises such as disease outbreaks heighten the vulnerabilities of different groups, accentuating inequalities and leading to the neglect of the needs and rights of the most marginalised. This includes women and girls living in poverty, migrants, people with disabilities, the elderly and people of diverse sexual orientation, gender identity and expression (SOGIE). Recognising the impact of the COVID-19 outbreak on marginalised groups is vital to ensure an effective health response which does not further endanger and exclude already vulnerable groups. Failing to take into consideration the specific impacts of COVID-19 on women and girls will result in a response which is less effective and does not meet the needs and requirements of half the population. Experience from past outbreaks such as the Ebola and Zika outbreaks have demonstrated the vital importance of incorporating a gender lens in to planning, response and re-building to ensure health interventions and humanitarian response are effective and promote gender equality. Recognising how COVID-19 affects women and men differently is fundamental to an effective response in health services and health communications, law and justice, security and education.