Republicans in the Senate provided six votes Tuesday that were needed to confirm Dr. Robert Califf as Commissioner of Food and Drugs by a 50-46 vote.

Califf is the 25th FDA commissioner and takes over the agency from Dr. Janet Woodcock who has served as acting commissioner since Joe Biden became President. She remains at FDA as a principal deputy commissioner under Califf.

Califf was also FDA’s 22nd Commissioner of Food and Drugs, having first served in the job during President Obama’s last year in office. Califf’s first confirmation came on an 89-4 Senate vote.

After winning support from the Senate Health, Education, Labor, and Pensions (HELP) Committee, Califf’s support unexpectedly began to erode among some Democrats who ordinarily would support their president’s choices for top jobs.  

Getting his confirmation vote was made all the more difficult by Sen. Ben Ray Lujan, (D-NM) being absent because he suffered a significant stroke. 

Among the Democrats not supporting  Califf was the powerful Sen. Joe Manchin of West Virginia. He said  Califf  bears “a great deal of responsibility” for drug overdose deaths that began occurring during Califf’s first tenure as FDA commissioner.

“Nothing that Dr. Califf has said or done has led me to believe he will operate the FDA any differently than he did during his previous tenure,” Manchin said.

Joining Manchin in voting  against Califf were Senators Richard Blumenthal, D-CN, Maggie Hassan, D-NH, Ed Markey, D-MA, and Bernie Sanders, I-VT.

But Califf enjoyed the support of six Republicans: Senators Susan Collins (Maine), Lisa Murkowski (Alaska), Richard Burr (North Carolina), Mitt Romney (Utah), Pat Toomey (Pennsylvania), and Roy Blunt (Missouri). In addition, Republican Sen. Mike Rounds, SD, was the non-voting “pair” with the absent Sen. Lujan of New Mexico. Rounds voted “present.”

The GOP votes offset the loss of five Democrats who ended up opposing Califf’s confirmation.

Six former FDA commissioners endorsed Califf, telling the Senate that an experienced hand is needed to run the agency that is still dealing with the pandemic. Califf is a prominent cardiologist with deep clinical research experience.

Califf has promised to quickly launch a comprehensive review of opioid painkillers like OxyContin, which helped trigger the worst drug epidemic in U.S. history after their FDA approval in the 1990s.

Opposition to Califf’s confirmation came from Democrats who do not like his ties to the pharmaceutical industry and anti-abortion advocates who blame him for abortion pill approvals.

Sen. Richard Burr, the ranking member of the Senate HELP Committee, made the case for Califf this way: “He has the robust agency and private sector experience needed to help build on the success of the FDA in helping Americans get back to normal life with the approval of tests, vaccines, and therapeutics that are bringing the pandemic to an end. He’s the leader we need today, but also for the future.”

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