After Califf survives narrow Senate vote, FDA nominee looks set to be confirmed this week

Standing alongside a poster of a young constituent, former West Virginia University cheerleader Lauren Cole, who died of an opiate overdose, West Virginia Senator Joe Manchin explained why he opposed the nomination of Robert Califf, M.D., to the FDA commissioner post.

Manchin was one of five Democrats in the Senate who voted against the nomination on Monday afternoon. But they were countered by five Republicans who supported President Joe Biden’s nominee, allowing Califf to survive by a tally of 49-45 in a procedural vote.

The result makes it a virtual guarantee that Califf will be the next FDA commissioner, a post he filled from February 2016 to January 2017 under President Barack Obama. For more than a year, the job has been filled by interim chief Janet Woodcock.

The Senate will take a formal vote later this week to confirm the nomination. The formal vote generally follows suit with the procedural vote.

North Carolina’s Richard Burr, the top Republican on the Senate’s Health, Education, Labor and Pension committee, was among those who supported Califf’s nomination. The other Republicans on board were Roy Blunt, Missouri; Susan Collins, Maine; Lisa Murkowski, Alaska; and Mitt Romney, Utah.

When Califf was confirmed in 2016, he cleared the Senate by a slam-dunk vote of 89-4.

Last month when the Health committee signed off on Califf’s nomination by a 13-8 vote, Republican Tommy Tuberville, Alabama, registered his dissent, saying Califf would “continue to advance this administration’s pro-abortion agenda.”

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At that time, Republican Mike Braun, Indiana, expressed similar sentiments.

Califf, a cardiologist, is viewed by some as too friendly to the pharmaceutical industry. Following his prior stint at the FDA, he became the chief of health strategy and policy at Alphabet, the parent company of Google.

For his part, Manchin’s objections to Califf surround the nominee's previous handling of the opioid crisis. In his first tenure, the FDA authorized too many opiate drugs, Manchin said.

“Dr. Califf has shown us who he is, and he has shown a complete lack of interest in actually making the difficult decisions that we need the leader of the FDA to make,” Manchin told the Senate Monday.

Other Democrats who voted against Califf were Richard Blumenthal, Connecticut; Maggie Hassan, New Hampshire; and Ed Markey, Massachusetts. Independent Bernie Sanders, Vermont, also gave a thumbs-down to Califf.

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The nominee has had to work hard to garner support. In recent weeks, Califf gained an important ally in Ron Wyden, D-Oregon, the chairman of the Senate Finance Committee who has long battled high drug costs. Another previously undecided Democrat, Debbie Stabenow, Michigan, recently said she would support the nomination.

“Americans are counting on the FDA to address serious health issues, from tobacco and e-cigarette use to the ongoing opioid and fentanyl crisis,” Wyden wrote last week. “I am prepared to support Dr. Califf’s nomination so that he can shift the FDA into high gear to take action on these challenges, and I will be watching closely to ensure that happens.”