President Trump’s nominee for surgeon general, Casey Means, currently lacks sufficient votes for Senate confirmation following a contentious hearing on public health policy. At least two Republican senators—Susan Collins of Maine and Lisa Murkowski of Alaska—have not committed to endorsing Means’ nomination.

The hearing centered on Means’ stance regarding vaccines, with Sen. Bill Cassidy (R-LA), chairman of the Senate Health Committee, pressing her on informed consent practices, measles outbreaks, and autism concerns. When asked whether she would recommend vaccinations during public health emergencies, Means emphasized patient-doctor discussions over direct advisement.

Cassidy also questioned Means about mifepristone and evidence linking vaccines to autism. Means affirmed acceptance of scientific consensus that vaccines do not cause autism but noted science remains “never settled.” She supported the CDC’s recent decision to discontinue routine hepatitis B birth dose recommendations, while stating universal childhood vaccination remains beneficial.

Means faced further scrutiny over past remarks about birth control pills being prescribed “like candy” and showing “disrespect of things that create life.” She reiterated that oral contraceptives should be accessible to all women but raised concerns about side effects in specific populations.

The Health, Education, Labor and Pensions Committee—split 12 Republicans to 11 Democrats—is pivotal for Means’ confirmation. A single Republican opposition could block her nomination. This follows the Senate’s recent confirmation of Robert F. Kennedy Jr. as head of the Health and Human Services Department despite his vaccine skepticism.

Murkowski stated it remains too early to determine her support for Means, noting previous assurances about vaccines made by the former secretary have “not been kept.” The outcome hinges on evolving committee dynamics and individual senator commitments.