Abstract
Pharmaceutical regulation plays a central role in protecting public health by governing clinical trials, market authorization, and post-marketing safety monitoring throughout the medicine life cycle. While substantial literature describes established systems, particularly the United States Food and Drug Administration (FDA), Japan's Pharmaceuticals and Medical Devices Agency (PMDA), and the European medicines regulatory network coordinated by the European Medicines Agency (EMA) together with national competent authorities, comparative analyses that integrate both mature authorities, emerging regulators and transnational harmonization networks remain limited. This narrative review draws on primary regulator/network documentation and targeted peer-reviewed literature to compare core regulatory functions across jurisdictions, including approval pathways and evidentiary expectations, inspection and good manufacturing practice (GMP) oversight, transparency practices, and pharmacovigilance and risk-management approaches. Across regions, we observe increasing convergence in scientific expectations through initiatives such as the International Council for Harmonisation (ICH) and reliance and work-sharing models, alongside persistent differences in legal mandates, resourcing, timelines, and data requirements. These differences are most consequential for complex products (e.g., advanced therapies) and in crisis settings, where emergency or conditional authorizations amplify the need for strong lifecycle monitoring, real-world evidence governance, and cross-border communication. We conclude by outlining opportunities to strengthen regulatory resilience and equity through fit-for-purpose harmonization, investment in enabling infrastructure, and future work on interoperable data systems, signal detection, and coordinated post-marketing evaluation.