The Senate on Tuesday confirmed Robert Califf as commissioner of the Food and Drug Administration, a key agency overseeing the U.S. response to the COVID-19 pandemic. The FDA had been without a permanent chief for 13 months. The vote was 50 to 46; with four Democrats and Sen. Bernie Sanders (I-Vt.) voting against Califf and six Republicans supporting his confirmation.

When President Biden nominated Califf, a cardiologist and expert in clinical trials, in November, the White House envisioned an easy confirmation, given that the Senate voted 89-4 to approve his first, brief stint as FDA chief in 2016. But some Democrats expressed concern that he would not be tough enough on the drugmakers because of his industry ties, and many Republicans voted no because of pressure from abortion advocates angry over the FDA’s moves to broaden access to the abortion pill.

The White House put in a lot of effort to get Califf across the finish line, including having him meet with more than a dozen senators to address their concerns. Califf will now help steer key decisions on COVID-19 vaccines — including whether to approve vaccines for kids under 5 — treatments, and tests, as well as how the FDA regulates tobacco products. But the FDA has a broad reach, regulating “products that account for 20 cents of every dollar spent by consumers,” from food to prescription drugs to “medicinal maggots for wound care,” The Washington Post notes.

Califf said his focus would be on the COVID-19 response, emergency preparedness, modernizing the FDA, and improving patient protections, The Wall Street Journal reports. Dr. Janet Woodcock, a veteran drug regulator who has led the FDA since January 2021 as acting commissioner, informed staff she will stay on principal deputy commissioner, the FDA’s No. 2 position.