CHARLESTON, W.Va (AP) — West Virginia Republican voters ousted the state Senate president during Tuesday’s primary elections, as well as an incumbent doctor who drew fire for breaking with his party over school vaccination policy.

In the state’s eastern panhandle, U.S. Army Special Forces Green Beret veteran Tom Willis defeated Republican Senate President Craig Blair, who has helmed the chamber since 2021. And State Health and Human Resources Chair Sen. Mike Maroney was defeated by Chris Rose, a former coal miner and power utility company electrician.

Maroney’s loss came after he publicly advocated against a bill pushed by the Republican caucus that would have allowed some students who don’t attend traditional public institutions or participate in group extracurriculars like sports to be exempt from vaccinations typically required for children starting day care or school.

West Virginia is only one of a handful of states in the U.S. that offers only medical exemptions to vaccine requirements. Maroney, a radiologist from Marshall County, called the bill “an embarrassment” on the Senate floor and said he believed lawmakers were harming the state.

Messages left for Willis, Blair, Maroney and Rose weren’t immediately returned Wednesday.

All 100 seats in the state House of Delegates were up for a vote, and 17 out of 34 state Senate seats. Fourteen Republican incumbents were up for reelection, with nine facing challengers. Four incumbents lost to challengers, including Blair, Maroney, Sen. Robert Karnes and Sen. Chandler Swope.

At least four Republican incumbents lost their House of Delegates primaries: Diana Winzenreid, David Adkins, Heather Tully and Don Forsht.

In one of the most contested races of the night, Republican incumbent Sen. Patricia Rucker narrowly defeated Del. Paul Espinosa. Espinosa was recruited to run for the state Senate after Rucker said she planned to challenge Blair for the Senate presidency. Facing pressure from Blair and other Senate leaders, she later dropped out of the Senate president race, but she was removed as Senate education committee chair.

Rucker endorsed Willis in his matchup against Blair.

Unaffiliated voters have been allowed to participate in Republican primaries in West Virginia since 1986, but this year marked the last time they could do that. The state GOP voted in January to close its primary to registered Republicans only starting in 2026. According to the secretary of state’s website, 24.7% of West Virginia registered voters have no party affiliation.

That last chance to vote in the GOP primary for unaffiliated voters could be one reason for an apparent jump in voter participation this year. According to unofficial totals, more than 224,000 West Virginia adults voted in the GOP presidential race. That compares with 198,000 in the 2020 GOP presidential primary and 157,000 in 2016.

In Maroney’s race, Rose had the backing of West Virginians for Health Freedom, a group that advocates against vaccine mandates.

During the debate about this year’s vaccine bill, which was ultimately vetoed by Republican Gov. Jim Justice, Maroney said: “I took an oath to do no harm. There’s zero chance I can vote for this bill.”

West Virginia law requires children to receive vaccines for chickenpox, hepatitis-b, measles, meningitis, mumps, diphtheria, polio, rubella, tetanus and whooping cough, unless they receive a medical exemption. West Virginia does not require COVID-19 vaccinations.

Alicia West Fancher, a mother who lives in a neighboring district to Maroney’s, is a member of West Virginians for Health Freedom and pushed for Rose’s election, said decisions about vaccines should be made by families, not legislators.

“To me, they’re playing God over the health of my children,” she said. “They don’t get to decide what’s right for my children. I get to decide with God’s help. It’s really sick to me to see all these politicians making health care choices over my family.”

Blair served three terms in the Senate, including the last three years as president. Before that, Blair spent seven years in the House of Delegates.

Willis has served more than two decades with the National Guard and is a real estate attorney. The Hedgesville resident is co-owner of the Glen Ferris Inn overlooking the picturesque Kanawha Falls in Fayette County. In 2018, Willis finished fourth among six candidates in a U.S. Senate GOP primary.