Dr. Robert Califf is seen before a hearing of the Senate Health, Education, Labor and Pensions Committee in November 2015 in Washington, DC.
CNN  — 

The Senate voted Tuesday to confirm Dr. Robert Califf as the next commissioner of the US Food and Drug Administration, despite opposition from some Democrats regarding his ties to the pharmaceutical industry.

The tally was 50-46. Six Republicans voted for Califf and five Democrats voted against his nomination.

Republican Sen. Mike Rounds of South Dakota voted “present,” in what is called a “live pair” with Democratic Sen. Ben Ray Lujan of New Mexico, who is absent from the chamber while recovering from a stroke. The “live pair” occurs when, as a courtesy to a member who is unable to attend a vote, a member with an opposing view abstains from casting a yes or no vote, in order to preserve the final vote’s margin.

“Senator Lujan is not able to vote, and in this Senate, on a bipartisan basis, we still try to work back and forth,” Rounds told CNN. “I am a no on this vote, he would have been a yes. For me it was an opportunity to maintain the same vote outcome, but to recognize the illness that one of our members has.”

“Mr. Lujan’s office had been looking to see if someone would pair with him,” noted Rounds, adding that Lujan is “not only a colleague, he is a friend.”

In this case, the pair did not change the outcome, as Califf had 50 votes without Lujan present.

However, for all his talk of bipartisanship, Rounds also sits on the Banking Committee, where Republicans on the panel boycotted votes in protest of President Joe Biden’s nomination of Sarah Bloom Raskin to be Federal Reserve’s vice chairwoman for supervision, halting the slate of all pending nominees for the central bank of the United States.

Rounds told reporters ahead of the committee meeting that he believes all committee members “should expect to get responses back to questions for the record that have been asked.”

Republicans on the committee have said that Raskin has not answered all of their questions.

“If they’re not being honored, then sometimes you have to send a message that the system has to be repaired,” Rounds said.

Califf, a longtime cardiologist, was previously confirmed to run the sprawling agency during President Barack Obama’s final year in office by an 89-4 vote. Prior to running the agency, Califf served as the FDA’s deputy commissioner for medical products and tobacco. He was a professor of medicine and a vice chancellor for clinical and translational research at Duke University before joining the FDA. He was also the director of the Duke Translational Medicine Institute and is the founding director of the Duke Clinical Research Institute.

He faced opposition from some Democrats – most notably Sen. Joe Manchin of West Virginia, who decried Califf’s ties to the pharmaceutical industry in a speech Monday.

“I will vote no on Dr. Califf’s nomination, and I have never been more profoundly confident of a vote I’m going to cast than I am right now,” Manchin said Monday ahead of a procedural vote that advanced Califf’s nomination.

“Dr. Califf has shown us who he is, and he has shown a complete lack of interest in actually making the difficult decisions that we need the leader of the FDA to make,” Manchin said. “Nothing that Dr. Califf has said or done has led me to believe he will operate the FDA any differently than he did during his previous tenure.”

This story has been updated with additional developments Tuesday.

CNN’s Lauren Fox contributed to this report.