Energy efficiency and conservation policy continues to take the proverbial “backseat” to energy access and renewable energy policy discourses in small island developing states (SIDS). In this study, we intend to motivate the energy efficiency policy agenda to encourage more action. To do so, we review the current energy challenges in SIDS and the role of energy efficiency in addressing those challenges, discuss the trends in the rate of improvement in energy efficiency in SIDS, exhibit an updated list of energy efficiency programs and initiatives being implemented in SIDS, consider barriers to energy efficiency implementation and set forth a policy-focused plan to accelerate action. Barriers for the adoption of energy efficiency policies continue to be institutional and policy- and governance-oriented; economic and financial; informational; and technical. A four-pronged policy advancement approach tackling initiation, incentivization, information and investment is recommended to tap the potential gains from energy efficiency. We attempt here, based on our findings, to offer a more practically executable plan of action, focusing squarely on combining institutional arrangements, policy requirements and current energy efficiency affairs in SIDS.