Trump’s FDA pick, Dr. Heidi Overton, faces doubts from Republicans as confirmation nears.

WASHINGTON — The Food and Drug Administration is set to complete its review of the safety of mifepristone, an abortion pill, in March, setting up one of the most politically charged decisions the agency has faced in years. And yet it may not have a permanent leader to oversee it.

Dr. Heidi Overton, President Donald Trump’s pick to lead the agency, is up for a vote next week before the Health, Education, Labor and Pensions Committee, but which top Republicans she needs remains unclear, just weeks before Democrats take control of the Senate.

“I haven’t taken a position,” Sen. Susan Collins of Maine said Thursday in a brief interview on Capitol Hill, adding that she needed “to get answers on various things.” Sen. Lisa Murkowski of Alaska declined to say how she would vote. During his confirmation hearing in September, Murkowski asked Overton about the political pressures surrounding access to mifepristone.

Sen. Bill Cassidy of Louisiana, chairman of the health committee, also declined to comment. Asked about his decision, he replied, “I’m a last-second guy,” laughing as he walked away from reporters on the moon.

But Cassidy was openly skeptical. Before Overton’s confirmation hearing, he wrote on X that he had “strong concerns” about her nomination, saying her lack of management experience left her ill-prepared to lead the agency.

In an article published Wednesday, Cassidy said he remained undecided, adding that he had “several frank conversations” with Overton and Jim O’Neill, Trump’s nominee for director of the National Science Foundation, about “their visions, their roles and the lack of trust that exists due to broken promises and irresponsible decisions by other administration officials.”

Senators could still be convinced before the committee vote next Wednesday, and the White House has given no indication that it plans to withdraw the nomination. The White House did not respond to a request for comment.

To advance to the full Senate, Overton needs 11 votes among the 21 committee members, meaning she can’t afford to lose a single Republican if all Democrats oppose her. After that, it will have to pass a vote in the Senate.

Time is also running out. Democrats, who took control of the Senate in the midterm elections, will take power on January 3. According to a former congressional aide, if Overton is not confirmed by then, her nomination would most likely be sent back to the White House and Trump would have to reappoint her before a Democratic-controlled Senate, where her chances would be slim.

Whoever runs the FDA will inherit a series of consequential decisions — from approving vaccines to reviewing the safety of mifepristone — in an agency that has been without a permanent commissioner since the resignation of Dr. Marty Makary in May.

Overton, a preventive medicine doctor, is responsible for domestic policy at the White House. She appeared alongside Trump when he signed an executive order to reduce the number of vaccines routinely recommended for children. During his confirmation hearing in September, Overton appeared to break with Health Secretary Robert F. Kennedy Jr. on vaccines, calling the measles, mumps and rubella vaccine safe and effective.

But his record on abortion has drawn scrutiny from Democrats. While working at the American First Policy Institute, a conservative think tank, she called the FDA’s decision to allow mail delivery of mifepristone “dangerous for women.” The agency is currently conducting a safety review of the drug, which Overton would oversee as commissioner.

During the hearing, she evaded questions about mifepristone, saying only that the product met FDA standards and that she did not want to prejudge the agency’s review.