The Senate on Wednesday confirmed Rachel Levine to be assistant secretary for health at the Department of Health and Human Services, making her the first openly transgender official ever approved by the upper chamber.

Levine, previously physician general and secretary of health in Pennsylvania, was confirmed by a vote of 52 to 48 on a mostly party line vote, with GOP Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) supporting the nomination.

Speaking on the Senate floor Wednesday ahead of the vote, Majority Leader Chuck Schumer (N.Y.) praised the confirmation as historic. 

“The arc of history is long but it keeps bending in the direction of justice,” he said. “As transgender Americans suffer higher rates of abuse, homelessness, and depression than almost every other group, it’s important to have national figures like Dr. Levine who, by virtue of being in the public spotlight, will help break down barriers of ignorance and fear.”

Republicans opposing her pointed to Pennsylvania’s record in fighting COVID-19, arguing that the state’s experience does not bode well for Levine to move up to fighting the virus on the national level. 

“Along with the testing challenges from last spring, your state failed to adequately protect nursing home residents from the virus, and is making unacceptable mistakes in the vaccine distribution process,” Sen. Richard Burr (R-N.C.), the top Republican on the Senate Health Committee, said at her confirmation hearing. 

He pointed to examples like confusion in the state’s vaccine rollout, including an instance where thousands of people received doses intended to be set aside for second doses as first doses. While the February incident occurred after Levine had left office, Burr said she had earlier been responsible for planning the vaccine rollout. 

At her hearing, Levine pointed to her efforts in Pennsylvania to fight the opioid crisis, including expanding the use of the overdose treatment naloxone by first responders. 

In the COVID-19 fight, she pointed to the state’s health equity task force, which engaged with Black and Latino community groups. 

Democrats noted that she was confirmed three times by the GOP-led state senate in Pennsylvania. 

“The historic nature of her nomination should not be lost on anyone, but Dr. Levine thoroughly deserves to be confirmed on the strength of her qualifications,” Schumer said.