Pharmacovigilance is critical in facilitating efforts targeted at closing the health gap by monitoring, assessing and preventing the occurrence of adverse drug reactions (ADRs) across diverse populations. This review aims to evaluate how pharmacovigilance systems can help mitigate healthcare inequalities specifically in low and middle-income countries (LMICs). The role of pharmacovigilance as part of the modern drug safety system integrated within a healthcare system became indispensable during the COVID-19 pandemic when drug decision-making required strong supervision systems in terms of vaccine safety. However challenges exist, such as lack of resources, training and inadequate infrastructure that is particularly apparent in LMICs. The manuscript considers the social determinants of health; structural inequities and other system factors that account for the differences in the health status and medication safety among different marginalized groups. The use of modern technology such as electronic health records coupled with data mining strategies is an effective way of enhancing pharmacovigilance. Community engagement, educating healthcare providers, and collaborating internationally appear to be strong strategies for enhancing pharmacovigilance systems. Case studies from Bolivia and Nigeria illustrate such a strategy effectively. The review concludes that healthcare professionals and drug monitoring systems must be strengthened, and improved and recommends a unified approach involving healthcare workers, policymakers, and communities to build robust, equitable drug safety monitoring systems.