Stephen Hahn, an oncologist and top official at MD Anderson Cancer Center, was confirmed Thursday as commissioner of the Food and Drug Administration. The Senate vote was 72 to 18.

Hahn, 59, takes over as the FDA juggles vexing political and health issues, including the Trump administration’s still-unresolved response to a surge in underage vaping over the past two years.

Other challenging issues awaiting him include Trump administration efforts to allow the importation of some cheaper drugs from Canada, the regulation of food and other products containing CBD, and the continued sales of unapproved treatments by commercial stem cell clinics. He becomes the fourth chief of the agency this year.

Forty-nine Republicans and 23 Democrats voted for Hahn’s confirmation. Seventeen Democrats, including Washington Sen. Patty Murray, the ranking member of the Health, Education, Labor and Pensions Committee voted no, along with independent Sen. Angus King of Maine.

Hahn told senators at his confirmation hearing last month that the rise of teen vaping was an “important, urgent crisis,” adding, “I do not want to see another generation of Americans become addicted to tobacco and nicotine and I believe that we need to take aggressive action to stop that.” He pledged to use science and data to guide decisions on that and other topics. But it’s clear the ultimate decision on vaping will be made by President Trump himself.

In September, the president said the FDA would ban non-tobacco-flavored e-cigarettes, a response to data showing almost 28 percent of high schoolers had vaped in the previous 30 days. But last month, Trump declined to finalize the ban because of concerns that job losses in the vaping industry and disgruntled vapers could hurt his reelection prospects. At a recent White House meeting with health groups, vaping advocates and tobacco executives, Trump expressed concerns that a flavored e-cigarette ban could lead to a rise in counterfeit products.

Sen. Richard J. Durbin (D-Ill.) who endorsed Hahn as commissioner on Wednesday and strongly favors a ban on flavored e-cigarettes, said the Texas cancer doctor might find himself responsible for implementing a vaping policy that will prove ineffective. “Dr. Hahn may find himself in a compromised position soon, and I told him as much,” Durbin said in a statement.

Several former FDA heads agreed curbing underage vaping should be Hahn’s top priority. “Every parent of a teenager is concerned their kids will become addicted,” said David Kessler, who served as commissioner during the George H.W. Bush and Clinton administrations and pushed for FDA authority over tobacco products.

Vaping advocates, meanwhile, say flavors are critically important to adults using e-cigarettes to quit smoking, and argue the youth-use problem can be eased by increasing the federal tobacco-purchasing age to 21 and taking other steps to make it harder for minors to get e-cigarettes.

Vaping is one of several tough issues pending at the sprawling FDA. With a budget of $5.7 billion, the agency regulates products accounting for about 20 cents of every dollar spent by U.S. consumers, including over-the-counter and prescription drugs, tobacco products and much of the nation’s food supply.

Robert Califf, FDA commissioner during the Obama administration, said key issues facing Hahn include the ongoing opioid epidemic and declines in life expectancy caused in part by chronic disease, suicide and depression.

He also urged Hahn to press forward with agency efforts to incorporate “real world evidence " — information from sources such as electronic medical records — in evaluating drugs. “We need much better evidence about medical products in practice,” he said.

One of the most sensitive issues facing Hahn involves Trump’s vow to allow states and others to import cheaper prescription drugs from Canada to ease the financial burden of high drug costs. The FDA, which has long been leery of importation for safety reasons, has sent the White House a proposed rule but officials at the Department of Health and Human Services view it as too restrictive and are trying to broaden it.

Former FDA Commissioner Scott Gottlieb, who stepped down from the post in April, said another early political challenge for Hahn will be the increasing congressional pressure for the FDA to create “an immediate path for CBD or cannabidiol to be added to food products.” After Congress legalized hemp last year, companies rushed to put CBD — which, unlike THC, is not psychoactive — in everything from cookies to coffees.

Recently, the FDA accused several companies of illegally selling products. The agency said that it couldn’t conclude that CBD is safe for human consumption, though it would continue “to explore potential pathways for various types of CBD products to be lawfully marketed.”

Mark McClellan, who was commissioner during the George W. Bush administration advised Hahn to continue pressing to reduce smoking and to keep “the agency up to date with the ever-advancing scientific environment,” including science-based approaches to reducing drug costs.

Hahn, a researcher as well as a medical and radiation oncologist, has most recently been chief medical executive at MD Anderson in Houston, responsible for the cancer center’s clinical care. He is the first permanent FDA commissioner since Gottlieb’s departure in the spring. In the interim, Norman “Ned” Sharpless, who was director of the National Cancer Institute and has since returned to that job, and Brett Giroir, assistant secretary for health at HHS, served as acting FDA chiefs.

In the early 1990s, Hahn worked at the NCI. He joined the University of Pennsylvania in 1996, serving as chair of radiation oncology from 2005 to 2014. He then moved to MD Anderson to become division head of radiation oncology. In 2017, he served as chief operating officer of the hospital during a period of big losses and staff cuts, and has been praised for helping engineer the cancer center’s financial turnaround.

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