Robert Califf has been narrowly approved to lead the Food and Drug Administration, giving the agency a Senate-confirmed commissioner for the first time in over a year.

Four Democrats and Independent Bernie Sanders joined most of the Republican members in voting against the nomination of Califf, who had been confirmed 89-4 to lead the FDA for about a year during the Obama administration.

Objections centered on Califf’s ties to the pharmaceutical industry and his role in regulation of an abortion drug, as well as what some perceived as his lack of a firm commitment to address the opioid crisis.

Sen. Ed Markey, D-Mass., said Califf had not pledged in a meeting to “the decisive and comprehensive action which we need, after years of agency failures and in the midst of a worsening opioid epidemic.”

Sen. Joe Manchin, D-W.V., also opposed the nomination. “Despite his pitch to overhaul the FDA's policy, during his tenure and immediately following it, the FDA approved five new opiates for the market” while removing only one,” he said.

And Sen. Steve Daines, R-Mont., said Califf “has a track record of putting an extreme abortion agenda above the science.”

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But Sen. Patty Murray, chairwoman of the Senate Health, Education, Labor and Pensions Committee, which approved Califf’s nomination 13-8, said “at this critical moment, we need a trusted hand to lead the FDA” and said Califf was well qualified, given his previous experience as head of the agency and his reputation as a leading research scientist.

Califf will have a number of issues important to the ag and food industries on his agenda, such as FDA’s regulation of products created using animal biotechnology, which industry would like to see streamlined if not removed entirely from FDA’s purview.

FDA also must decide when manufacturers can label products as "healthy," which is now done for about 5% of all packaged foods. The agency also is due to finalize new safety rules for water used to grow produce, and is considering revoking a health claim that says consumption of soy protein can help reduce the risk of coronary heart disease

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