Voting mostly along party lines, the U.S. Senate has confirmed former Pennsylvania Health Secretary Rachel Levine to be the nation’s assistant secretary of health. She is the first openly transgender federal official to win Senate confirmation.

The final vote Wednesday was 52-48. Republican Sens. Lisa Murkowski of Alaska and Susan Collins of Maine joined all Democrats in supporting Levine.

Levine had been serving as Pennsylvania’s top health official since 2017, and emerged as the public face of the state’s response to the coronavirus pandemic. She is expected to oversee Health and Human Services offices and programs across the U.S.

President Joe Biden cited Levine’s experience when he nominated her in January.

Levine “will bring the steady leadership and essential expertise we need to get people through this pandemic - no matter their ZIP code, race, religion, sexual orientation, gender identity or disability,” Biden said.

Transgender-rights activists have hailed Levine’s appointment as a historic breakthrough. Few trans people have ever held high-level offices at the federal or state level.

However, the confirmation vote came at a challenging moment for the transgender-rights movement as legislatures across the U.S. - primarily those under Republican control - are considering an unprecedented wave of bills targeting trans young people.

One type of bill, introduced in at least 25 states, seeks to ban trans girls and young women from participating in female scholastic sports.

Another variety of bill, introduced in at least 17 states, seeks to outlaw or restrict certain types of medical care for transgender youths. None of these measures has yet won final approval.

Issues related to transgender rights also are a major factor in Republican opposition to the proposed Equality Act, which would extend federal civil rights protections to LGBTQ people across the U.S. The measure has passed the Democratic-led House but likely needs some GOP votes to prevail in the Senate.