Democrat Dr. Amy Acton has defeated Trump-backed Indian-American Republican candidate Vivek Ramaswamy in the Ohio gubernatorial election, becoming the first woman elected governor of the state. Her victory also marks the first time since 2006 that Ohio has elected a Democratic governor.

Acton, 60, is a physician and former director of the Ohio Department of Health, where she worked alongside Republican Governor Mike DeWine during the COVID-19 pandemic. She overcame more than $100 million in spending by Ramaswamy and his Republican allies to secure the victory.

She will succeed DeWine, who is barred by term limits from seeking another term.

Acton built her campaign around affordability, healthcare access and the concerns of working- and middle-class families. An Ohio native, she frequently spoke about her difficult childhood, including periods of homelessness and a winter when she lived in a tent.

Acton capitalises on affordability concerns and Ramaswamy’s wealth

Acton’s campaign portrayed Ramaswamy, a biotechnology entrepreneur and former 2024 presidential candidate, as out of touch with ordinary Ohioans struggling with rising living costs.

Her campaign highlighted concerns over fuel prices, the cost of living and the impact of President Donald Trump’s tariffs on American households.

Ramaswamy and Republican allies spent more than $100 million supporting his candidacy and opposing Acton. Billionaire Elon Musk also contributed at least $5 million to a political action committee supporting Ramaswamy, according to the Associated Press.

Despite receiving Trump’s endorsement and campaign appearances by both Trump and Vice President JD Vance, Ramaswamy failed to overcome Acton’s appeal among voters.

Ramaswamy had secured early backing from Ohio Republicans. DeWine had appointed Republican Jon Husted to the US Senate after JD Vance vacated the seat to become vice president. Husted had previously been considered a leading contender for the gubernatorial nomination.

Ramaswamy’s Republican primary campaign also faced competition from Casey Putsch, a vehicle designer and YouTube personality known as “The Car Guy.” Putsch attracted nearly 18 per cent of the Republican primary vote despite spending relatively little on his campaign. He later announced his intention to vote for Acton.

Controversial advertisement featuring Acton’s estranged mother sparks backlash

The campaign was also overshadowed by controversy over a political advertisement featuring Acton’s estranged mother, Donna Arthur.

The advertisement, produced by Ramaswamy’s campaign, showed Arthur accusing her daughter of lying about her childhood and urging voters not to support her.

The advertisement drew widespread criticism after details emerged about the family’s history. Arthur had lost custody of her children in 1978 after her husband, Acton’s stepfather, was indicted on a charge of raping Acton when she was 12. Acton and her brother were subsequently removed from their mother’s custody.

The advertisement prompted bipartisan criticism from former Ohio governors, political leaders, women’s organisations and hundreds of alumni of Ramaswamy’s former Catholic high school in Cincinnati.

Trump and Vance defended Ramaswamy’s decision to run the advertisement, while several Republican figures called for its withdrawal.

Ramaswamy eventually stopped airing the advertisement shortly before Election Day. Although his campaign had initially announced a $4 million advertising commitment, tracking data cited by the Associated Press indicated that approximately $1 million was actually spent airing it.

Former pandemic health director returns to state leadership

Acton became one of Ohio’s most recognisable public figures during the early months of the COVID-19 pandemic. As state health director, she appeared alongside DeWine and Husted in public briefings explaining the state’s response to the health crisis.

During the gubernatorial campaign, Ramaswamy and his allies criticised her pandemic-era decisions, particularly restrictions affecting schools and businesses.

DeWine, however, defended his former health director, maintaining that responsibility for the state’s policy decisions ultimately rested with him, even as he endorsed Ramaswamy in the election.

Acton will enter the governor’s office without having previously held elected office. Her victory represents a major political breakthrough for Ohio Democrats after two decades without winning a gubernatorial election.

It also marks a setback for Trump and his allies in a state that has increasingly leaned Republican in recent presidential elections.