However, a device like the Garmin inReach requires an active subscription for the SOS to work. If there's a glitch with your credit card and the service becomes inactive while you're on travels, it might not work.
Another difference is that an inReach SOS message goes to the Garmin-run https://www.iercc.com/en-US/about/ rescue coordination center who will the relay to rescue services.
Whereas a PLB or EPIRB communicate with the Cospas-Sarsat system and is handled directly by government rescue agencies (https://www.sarsat.noaa.gov/mission-control-center). While the Garmin service works great, I have more trust in the USMCC being always responsive than any private company.
So the best advise is to have both. I have an EPIRB (for boating) and a couple PLBs in addition the the Garmin inReach. I use the inReach for casual messaging but if I ever have a real emergency I'll activate the PLB and EPIRB first and only afterwards start trying to message via the Garmin.
Actual PLBs (not SPOT) have a backup strategy in the event the GPS signal is obscured by mountains.
If the device can't get a reliable GPS fix, the satellites will resort to measuring doppler shift as they pass overhead to locate the transmitter. It's slower (takes several passes of the satellite, so we're talking hours) and less accurate, but it will get rescuers to the general direction.
From there, PLB devices also transmit a low-power homing signal on 121.5 MHz (the aviation distress frequency) that SAR teams can locate using radio direction-finding equipment.