The Senate has approved Vivek Murthy to serve as U.S. surgeon general, despite opposition from Republicans and the gun rights lobby because of his political advocacy work and statements calling guns a public health concern.

Murthy, 37, who has business and medical degrees, is a physician at Boston’s Brigham and Women’s Hospital and instructor at Harvard Medical School. He won confirmation on a vote of 51-43. The son of immigrants from India is a co-founder of Doctors for America, a group that has pushed for affordable health care and supports President Barack Obama’s health care law. He also created a nonprofit that focused on HIV/AIDS education in India and the U.S., and co-founded a technology company, TrialNetworks, that helps drug developers collaborate on clinical trials.

The U.S. has been without a Senate-confirmed surgeon general since July 2013. The surgeon general does not set policy but is an advocate for the people’s health and and oversees the U.S. Public Health Service Commissioned Corps and its 6,700 members. Murthy is the first Indian American to serve in the role.

At a Senate hearing in February, Murthy said he wouldn’t use the position of surgeon general to push gun control. He said his priorities include helping communities promote healthier living.

The near party-line vote Monday secured a four-year term for him. Sen. Mark Kirk, R-Ill., joined Democrats in support. His nomination had been pending for more than a year.

Obama made no reference to his nominee’s gun policies or politics in a statement on the confirmation vote. He said his priorities would range from “stopping new diseases to helping our kids grow up healthy and strong.” He will also work on the effort to combat the spread of Ebola.

In a Senate floor speech earlier Monday, Sen. John Barrasso, R-Wyo., an orthopedic surgeon, questioned the breadth of Murthy’s medical experience because he completed his medical residency in 2006. “The majority of his career has been spent not as a doctor treating patients but as an activist — an activist focused on gun control and political campaigns,” he said.

Supporters said Murthy is well-qualified and noted his promise not to use the position as a bully pulpit for gun control.

Murthy’s confirmation “makes us better positioned to save lives around the world and protect the American people here at home,” Obama said in a statement. Murthy “will also help us build on the progress we’ve made combatting Ebola, both in our country and at its source” in West Africa.

He is also the latest in a string of executive nominees who only able to pass the Senate after Majority Leader Harry Reid, D-Nev., pushed through a rules change last year to lower the threshold from 60 to 51 votes to advance certain presidential nominations. Republicans have not said whether they will keep the rules change in place in the next Congress.

Murthy replaces acting Surgeon General Boris Lushniak, who has been serving since Regina Benjamin resigned in July 2013.

The White House announced in November 2013 that Obama would nominate him. Since then, Murthy has been endorsed by more than 100 health organizations, including the American College of Physicians, the American Heart Association and the American Diabetes Association.

However, Murthy’s political advocacy for Obama and statements on gun control slowed his nomination. He was opposed by the National Rifle Association for his support of stricter gun laws, including an assault weapons ban, and a number of public statements asserting that guns are a public health issue. “America’s next surgeon general should not be a political operative whose professional inexperience has been a source of bipartisan concern,” said Andrew Arulanandam of the NRA.

The NRA announced it would “score” the vote as part of the system it uses to rate lawmakers in political campaigns.

Republican Sen. John Barrasso said most of Murthy’s career has been spent as an activist focused on gun control and other political issues, rather than on treating patients. “Americans don’t want a surgeon general who might use this position of trust to promote his own personal campaign against the Second Amendment of the Constitution,” he said.

Murthy expressed support for gun control in a letter to Congress after the Newtown, Conn., school shooting in December 2012, in which a gunman killed 20 children and six educators. He also tweeted: “NRA press conference disappointing but predictable — blame everything in the world except guns for the Newtown tragedy. #wakeup.”

The vote on his confirmation is the only congressional vote in this Congress to overcome NRA opposition. Dan Gross, president of the Brady Campaign to Prevent Gun Violence, called it a “huge victory” for gun control advocates. “Now we have a surgeon general who recognizes that gun violence is a serious public health issue that America urgently needs to address,” he said.

“Today’s vote should send a clear message to all members of Congress that it is possible to take on the NRA and win,” added Becky Bond, political director at CREDO, a progressive activist group.

Senate Majority Whip Dick Durbin, D-Ill., said Murthy has made clear that he is not “aspiring to be the leading doctor in America to engage in a political debate.”

Not all Democrats were convinced. Sen. Joe Manchin, D-W.Va., announced his opposition Monday, citing that activism. “After meeting with Dr. Murthy, I don’t question his medical qualifications. I just question whether the public will believe that he can separate his political beliefs from his public health views,” he said.

Democrats delayed a vote on Murthy’s nomination until after Election Day, in part because many of the party’s senators up for re-election were running in conservative states where the NRA holds considerable political sway. But Democrats lost control of the Senate anyway, paving the way for a nomination vote in a lame-duck session before Republicans take over in January.

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