Drugs are often approved overseas before being approved in the states. Pradaxa comes to mind because I worked for the company that brought it to market at the time. It was available overseas for a couple years first. It may not always be the same indications for use that ultimately get approved in the US but drugs can definitely be marketed overseas before FDA approval. That being said, I’m sure there are a lot of regulatory bodies that look to the FDA for approval first because the process is pretty rigorous and if approved here it should (“should” but we all see what’s going on with Remdesivir) be based on sound science and proven results.