The United States Senate has approved former environmental lawyer Robert F Kennedy Jr to lead the federal government’s Health and Human Services Department (HHS), in the latest controversial vote over a cabinet nominee picked by President Donald Trump.

But Thursday’s vote was narrow, given Kennedy’s history of embracing anti-vaccine views and health-related conspiracy theories.

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Still, there was one notable Republican defection: Senator Mitch McConnell of Kentucky, a childhood polio survivor and former leader of the party in the Senate. He had previously warned Trump nominees to “steer clear” of “efforts to undermine public confidence in proven cures”.

The leaders of the minority Democrats in the Senate, Chuck Schumer of New York, sought to appeal to Republicans in the minutes before the vote. He called the prospect of Kennedy leading a federal department tasked with ensuring public health and safety “dangerous”.

“ My colleagues on the Republican side, you know the consequences of what you’re doing. My colleagues on the Republican side, you know how dangerous this is. My colleagues on the other side, you know you are not putting your constituents — their health, their families — first when you vote yes,” Schumer said.

Republicans, however, have small but solid majority in the Senate, holding 53 seats.

And Trump has so far been successful in getting all his nominees to high-level government positions confirmed, despite controversies over some of them.

That includes Director of National Intelligence Tulsi Gabbard, who was confirmed on Wednesday despite past statements expressing sympathy for Russia’s “legitimate security concerns” as it invaded Ukraine in 2022.

Pentagon chief Pete Hegseth, meanwhile, was approved in January after the Senate was evenly split, 50-50, over his nomination, given allegations of sexual misconduct and drinking alcohol on the job. Vice President JD Vance ultimately cast the tie-breaking vote.

Kennedy himself faced no shortage of controversy in the lead-up to Thursday’s vote.

His cousin, former US Ambassador Caroline Kennedy, issued an open letter calling him a “predator” who has continued to “lie and cheat his way through life”.

Democrats have also sought to highlight his history of vaccine scepticism. Though he testified in his confirmation hearings that his own children were vaccinated, Kennedy has spread debunked conspiracy theories, including that vaccination was linked to autism.

He was also linked to a deadly measles outbreak in Samoa that caused an estimated 83 deaths. While Kennedy has denied his visit was about vaccines, health officials on the island have accused him of spreading doubt about the efficacy of the prevention tool.

In his final words before Thursday’s vote, Schumer warned Republicans against following Trump’s lead by approving Kennedy for the high-level health position, calling it “wrong, very wrong”.

He encouraged to buck the party leadership and vote with their conscience.

“ Today, the question in front of this body is not simply to confirm RFK to run the nation’s health department. The question before us is very simple: Which is more important to you? The health and wellbeing of your constituents, or blindly obeying orders?”