Trump's FDA pick can't lose a single Republican vote next week

Dr. Heidi Overton, President Donald Trump's pick to run the Food and Drug Administration, gets her committee vote next Wednesday — and she still doesn't have the Republican votes locked down. Overton needs 11 votes in the 21-member Health, Education, Labor and Pensions Committee, which means with all Democrats expected to oppose her, one Republican defection sinks her. From there, she'd need to clear the full Senate.

The holdouts aren't hiding. Sen. Susan Collins of Maine said flatly Thursday on Capitol Hill that she has "not taken a position," adding she needs "to get some answers on various things." Sen. Lisa Murkowski of Alaska wouldn't say how she'd vote. During Overton's September confirmation hearing, Murkowski pressed her on political pressure surrounding access to mifepristone.

Committee chairman Bill Cassidy of Louisiana also clammed up, then moonwalked away from reporters with a laugh and the line, "I'm a last-second sort of guy." He's been anything but quiet before, though — ahead of her hearing he posted on X that he had "strong concerns" about the nomination, pointing to her thin managerial experience. On Wednesday he said he was still undecided after "several frank conversations" with Overton and Jim O'Neill, Trump's nominee to lead the National Science Foundation, about their visions, roles, and "the lack of trust that exists due to broken promises and irresponsible decisions from other officials within the Administration."

The deadline is brutal. Democrats won the Senate in the midterms and take power Jan. 3, and according to a former congressional aide, an unconfirmed Overton would most likely see her nomination returned to the White House — forcing Trump to re-nominate her into a Democratic-controlled Senate where her odds would be slim. The White House hasn't signaled any plan to pull her, and didn't respond to a request for comment.

Whoever lands the job inherits a pile of politically explosive calls, including a safety review of the abortion pill mifepristone due to wrap in March. The agency has had no permanent commissioner since Dr. Marty Makary resigned in May.

Overton is a preventive medicine doctor and a domestic policy official in the White House who stood beside Trump as he signed an executive order aimed at cutting the number of vaccines routinely recommended for children. At her hearing she broke with Health Secretary Robert F. Kennedy Jr. on vaccines, calling the measles, mumps and rubella shot safe and effective, but sidestepped mifepristone questions, saying only that it met FDA standards and she didn't want to prejudge the review. Her old writing has Democrats fired up: at the America First Policy Institute, a conservative think tank, she called the FDA's move to allow mail delivery of mifepristone "dangerous to women."