Ethical research governance across Pacific island countries and areas (PICs) faces challenges from limited local capacity and disproportionate external influences. However, a shared commitment to advance and strengthen ethical oversight is increasingly emerging. In May 2025, WHO, the Pacific Community, and the Pacific Academy of Sciences convened a workshop with PIC representatives to review existing health research ethics ecosystems and define priorities for improvement. Mapping efforts revealed wide disparities: some countries have formal legal frameworks and established ethics committees, while others rely on informal processes or external approvals. Concerns were expressed about externally driven research, limited local control, inconsistent consent practices, and weak mechanisms to ensure communities benefit from research. Key priorities included developing national policies that clarify governance roles and standards, creating Pacific-wide ethical research guidelines that reflect regional values, and embedding long-term capacity building and fair benefit-sharing into research partnerships. The workshop highlighted that ethical research governance is not only a technical necessity but also central to self-determination, cultural integrity, and equity. Moving forward, progress will require sustained investment, regional collaboration, and global partners to support research led by the Pacific, for the benefit of Pacific communities.