Health Commissioner Jan Malcolm has become one of the most recognizable public servants in state government over the past 19 months, bumping elbows with vice presidents, getting vaccinated (including a booster jab) in front of TV cameras and spending hundreds of hours on the air updating citizens on the fight against COVID-19.

She's also at risk of losing her job.

Republicans in control of the state Senate are threatening to reject her confirmation in Gov. Tim Walz's administration, part of a national trend of conservatives targeting public health officials over decisions on vaccines, mask mandates and business closures.

"There's no one in the country who has this position who is going to win any popularity contests, on either side," said Charlie Weaver, executive director of the Minnesota Business Partnership, who served alongside Malcolm in former Gov. Jesse Ventura's administration. "Some are criticized for not doing enough, some are criticized for doing too much."

The rejection threats have prompted Democrats in the governor's office and state House to take steps to protect Malcolm. They have halted plans for a fall special session to send aid to front-line workers and farmers struggling after the summer drought, fearing Republicans could also take out Malcolm as part of the agenda.

"It's ridiculous. I hope that gets slowed down just a bit," Walz said Wednesday as the state rolled out its plan to vaccinate 5- to 11-year-olds. He cited the extensive preparations that went into the vaccination plan as a prime reason to hang onto Malcolm, who Democrats have praised for helping guide Minnesota through the pandemic.

"I know if I'm on the phone for countless hours, hundreds of hours went into it before it ever got sent to me. ... That's the job that's being managed by Jan Malcolm," Walz said. "I've never wavered once. I still every day gain more admiration and awe of the work the commissioner has to do."

Malcolm declined to be interviewed for this story through a spokesperson, who said she is "focusing on the state's pandemic response, and not speculation."

Malcolm has delivered counsel to three administrations, starting as Ventura's health commissioner. She was called back by former Gov. Mark Dayton in 2018 after a backlog of elder abuse complaints led Health Commissioner Ed Ehlinger to resign. She eliminated the backlog within eight months, earning bipartisan applause.

Weaver worked alongside Malcolm in the Ventura administration after the 9/11 terrorist attacks, when the public feared another attack was on the way. She led the health side while he led the state's public safety agency.

"It's easy to panic. People are already on edge, but she never did," said Weaver, a former Republican legislator and chief of staff to former Republican Gov. Tim Pawlenty. "It's so important to have a leader who is calm and thoughtful and clear. I don't know how many news conferences she did, but she was never afraid to stand in front of those cameras and give her best opinion."

He said it's a commissioner's job to give their boss advice, but governors ultimately dictate the terms of any policy. Republicans have eyed Walz's commissioners nonetheless as players in an administration they believe has dramatically overstepped during the pandemic.

Last year, Republicans rejected two members of Walz's cabinet in special sessions: Labor and Industry Commissioner Nancy Leppink and Commerce Commissioner Steve Kelley. Minnesota Pollution Control Agency Commissioner Laura Bishop resigned in July ahead of another expected rejection by the Senate.

A previous defender of Malcolm, Sen. Jim Abeler, R-Anoka, said he changed his perspective as the state began its vaccine rollout. He has concerns about the potential side effects of the vaccine and doesn't believe Malcolm has done enough to warn people about the risks.

At a "Medical Freedom Rally" at the Capitol in August, he told a crowd of roughly 2,000 people he no longer believes she should remain in her job. The crowd cheered.

"You don't have to be anti-vaccination to wonder about safety," Abeler said. "When I decided to make my statement, I wanted to provoke a conversation about safety."

Since then, medical freedom rallies have occurred monthly in St. Paul, and more members of the Senate GOP have been talking openly about the possibility of rejecting Malcolm — including new Senate Majority Leader Jeremy Miller, R-Winona, who was elected in September to lead the caucus.

Others have cited concerns about a possible vaccine mandate and a passport system requiring proof of vaccination as reasons to take a closer look at Malcolm's appointment.

Senate Health and Human Services Chair Michelle Benson, R-Ham Lake, declined to comment, and Miller was unavailable for comment. But in an interview last month he said Walz had "shut the people out" on many COVID-related decisions, including the launch of an immunization-records app.

"To me, that's shutting the people out of the conversation because the conversation with the people is had [by] going through the legislative process," he said.

State employees are required to be vaccinated or tested to work in person, and the state has an app for people to store their vaccination documentation. There's no statewide vaccine mandate or passport system in place.

Regardless, Abeler said many Republicans are concerned that a vaccine passport system could still be on the way. "If we can find a way to assure people that we're not going to do that, that would make a lot of people feel better," he said.

The possible rejection of other commissioners is also being discussed behind the scenes, but only Malcolm has been named publicly. The Senate has constitutional power to confirm or deny the appointment of commissioners, a power that's been used sparingly in the past. Senate Democrats rejected two of Pawlenty's commissioners over the span of his two terms in office.

Democratic House Speaker Melissa Hortman said Republicans are using Malcolm's appointment as leverage for changes they want to make to the state's emergency powers law, which Walz used to institute mask mandates and close businesses and schools to slow the spread of the virus.

"This is not a part of Minnesota history. We've seen a failure to confirm here or there, but we're far beyond where the scoreboard is even," said Hortman, DFL-Brooklyn Park. "The Republicans in the Minnesota Senate have gone to an extreme in the way they are using commissioner confirmations."

Democrats can delay action on Malcolm by waiting to call a special session, which only the governor can do. But Malcolm's appointment could be considered during the regular legislative session, which convenes in January. Miller has said confirmations should be on the table.

"Buckle up for the regular session," said Senate Minority Leader Melisa López Franzen, DFL-Edina. She believes the narrow Republican majority would have a hard time coming up with enough votes to oust Malcolm — particularly with its members from Rochester, home of the Mayo Clinic, which has partnered closely with the administration on combating COVID.

"Hopefully by then we have things under control," López Franzen said. "But that puts undue stress on someone's livelihood and someone's job."

Star Tribune staff writer Jessie Van Berkel contributed to this report.