Vivek Murthy became the nation’s top doctor Monday, but only after a protracted fight over firearms.

The Senate narrowly confirmed a new surgeon general whose nomination was delayed for months in a fight over his comments alleging that guns are a public health issue. The confirmation represents a victory for gun-control advocates, even as recent polling has shown Americans moving in the other direction toward gun-rights protections.

The Senate’s 51-43 vote confirming Massachusetts physician Vivek Murthy as the next surgeon general marks the end of a protracted fight over gun control and Murthy’s views on it. Murthy, who will be the first Indian-American surgeon general to serve in the U.S., waited more than a year for Senate confirmation after the National Rifle Association and other pro-gun groups threatened to throw their resources against members supporting his nomination. Senate Majority Leader Harry Reid determined earlier this year that he couldn’t put his red-state members in that position before the 2014 midterm elections and shuffled Murthy to the back of the nominations pile.

Indeed, three pro-gun Democrats opposed the nomination on Monday evening: Sens. Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, and Joe Manchin of West Virginia. Manchin is up for reelection next year in an increasingly red-leaning state and is already facing Republican attacks—particularly on guns. Manchin, who won his seat in part thanks to his Second Amendment bona fides, lost the favor of the NRA in the wake of the Sandy Hook Elementary shootings, when he cosponsored legislation with Republican Sen. Pat Toomey to tighten restrictions on gun ownership.

Murthy got supporting votes from the five Democrats who lost their seats in the 2014 midterm elections: Sens. Mark Begich of Alaska, Kay Hagan of North Carolina, Mary Landrieu of Louisiana, Mark Pryor of Arkansas, and Mark Udall of Colorado all voted for Murthy, despite having faced advertising that questioned their commitment to gun rights throughout their campaigns.

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