The South Pacific island countries (SPIC) are among the most vulnerable countries in the world to economic shocks, climate change and natural disasters. Agriculture including livestock production makes important contribution to socio-economic development in the region. However, the livestock sector is marred by many livestock diseases, which are crippling the economies as well as threatening the food security of the island nations, most of which have high dependence on imports. Limited veterinary medical facilities, high cost of conventional medicine and remoteness of some rural farming communities make it difficult for farmers to treat their diseased animals. Nevertheless, the island nations are endowed with vast reserves of medicinal plants in diverse ecosystems including mangroves, rainforests and tropical dry forests. Despite the ubiquity of traditional medicine systems, most of the plant species have been used to treat human aliments in the SPIC and very few farmers utilise herbal medicine to treat their animals. This review highlights the common diseases affecting livestock production in the SPIC, threats to ethno-veterinary knowledge, and potential plant species and their efficacies to treat animal diseases and parasites. It also discusses the common methods of preparation of veterinary herbal medicine and possible ways of making the medicine available in the formal and informal markets in the region. It is envisaged that the review will stimulate further ethno-veterinary research among livestock disease management practices in the SPIC.