“I have never been more profoundly confident of a vote I’m going to cast than I am right now,” Mr. Manchin said in a fiery floor speech on Monday, directly placing partial blame for the worsening epidemic on Dr. Califf. Opposition to his nomination, Mr. Manchin added, would “send a message to this administration, to our president, that we need a new direction at the F.D.A.”
“We need people who want to protect us,” he concluded, “not people who allow drugs to destroy us.”
Just before the vote on Tuesday, Senator Edward Markey, Democrat of Massachusetts, denounced the F.D.A.’s role in becoming the “country’s biggest pill pusher” and said Dr. Califf did little to address the problem in his previous stint as commissioner.
“There was no real commitment to reforming the F.D.A. or to learning from the mistakes that enabled this public health crisis,” Mr. Markey said.
Dr. Califf also faced pressure from abortion foes over the F.D.A.’s risk-management policies related to abortion medications. The influential Susan B. Anthony List organization, which opposes abortion, has canvassed lawmakers about changes made during Dr. Califf’s prior tenure as commissioner that eased access to medication abortion pills.
During a Senate hearing in December, Dr. Califf expressed confidence in the agency’s ability to handle decisions about the medications again. Two days after that hearing, the F.D.A. announced that women could receive the pills by mail after a telehealth appointment, eliminating a requirement for an in-person evaluation.
The Susan B. Anthony List announced that it would “score” the vote on Dr. Califf’s nomination, meaning it will be considered in the organization’s assessments for lawmakers’ “pro-life scorecard.” Republicans up for re-election often seek the group’s endorsement.
Senator Steve Daines, Republican of Montana, spoke in opposition before the vote, criticizing Dr. Califf’s role in the abortion medication changes.