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With Rachel Roubein and Dan Goldberg

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— With a late-night infrastructure vote in the rear view, Senate Democrats are setting their sights on a budget resolution framework this week potentially loaded with health provisions.

— Vaccine demand has surged amid variant fears but it’s still unclear whether the needle will move on overall vaccination rates.

— A storm of anti-trans health care bills landed at state capitols this year as Biden officials, including the nation’s highest-ranking openly trans official, push for more inclusive care.

WELCOME TO MONDAY PULSE — The Olympics are over, but the mental health conversation has just begun. Send tips to [email protected] and [email protected].

DEMS’ BUDGET RESOLUTION ON THE HORIZON — Senate Budget Chair Bernie Sanders plans to release the budget framework for Democrats’ $3.5 trillion social spending bill this week — and the Senate is expected to take it up before breaking for August recess.

The text won’t allocate specific funding levels for new health initiatives — like expanding Medicare and bolstering Medicaid’s in-home care — but instead broadly give different committees with health policy jurisdiction pots of money to work with, Rachel Roubein and Alice Miranda Ollstein reported. Democrats are already openly acknowledging that they’ll likely have to make some new health programs temporary — or entirely drop some progressive asks, like lowering the age of Medicare — in order to fit within the budget resolution’s topline number.

Sanders shared his timeline Sunday night, hours before senators’ cloture vote on the multibillion infrastructure package they spent the weekend finalizing.

FEAR MAY WORK BETTER THAN FAUCI — Demand for the Covid-19 vaccine is hot once again in states hardest hit by the Delta variant thanks, in large part, to a panicked public concerned over the latest wave of infections and hospitalizations, Dan Goldberg writes.

A recent poll found that more than half of unvaccinated people believe the vaccine is a greater risk to their health than Covid, but hearing local doctors recount stories of dying patients, and soon-to-be-widows begging for the shot — only to be told it is too late — may be forcing many to recalibrate their analysis.

But whether the recent spike in demand will meaningfully boost vaccination rates, which are still below 50 percent in more than a dozen states, remains to be seen. The newfound enthusiasm for the shots may wane as quickly as it started, depending on how deep the fear of Delta runs and how long the current surges last.

Officials in Missouri, Louisiana and Arkansas, all states where the vaccination rate is still well below the national average, worry that the increased interest in the Covid-19 shots won’t last — or that it won’t be sweeping enough to help communities ward off outbreaks when the weather turns cold and people spend more time indoors.

GOP’s PLAYBOOK AGAINST TRANS YOUTH HEALTH CARE — A rash of bills introduced in at least 20 states would limit trans youth’s access to gender-affirming care — and opponents say they echo past arguments anti-abortion groups put forth about women’s safety as they attempted to shut down clinics, Joanne Kenen writes.

The tensions over trans rights — which swirl around restrictions on bathroom use, participation in school sports and health care — have intensified even as the courts and society have grown generally more accepting of LGBTQ rights.

Most of the bills stalled this year, but supporters plan to reintroduce many of them in 2022 — a year when the conservative Supreme Court will decide a landmark Mississippi abortion case that could overturn or curtail Roe v Wade and when the November congressional elections will determine whether President Joe Biden will retain a Democratic majority in Congress.

“It’s egregious,” said HHS Assistant Secretary for Health Rachel Levine, the nation's highest-ranking openly trans public official and a pediatrician who specializes in adolescent medicine.

Organizations including the American Academy of Pediatrics and the American Psychiatric Association oppose the state bills, many of which would penalize doctors who prescribe puberty blockers, which prevent the patient from undergoing physical changes that don’t fit with the individual’s gender identity.

“What health problems are they trying to solve?” asked Alphonso David, a civil rights lawyer who is president of the Human Rights Campaign. “They are looking to devalue and demonize trans people. They are shifting strategies from the bathroom issues to sports and medical issues.”

ZEKE EMANUEL FLOATED FOR FDA CHIEF — Biden officials in recent weeks have discussed University of Pennsylvania bioethicist Ezekiel Emanuel as a candidate to lead the Food and Drug Administration, according to four people with knowledge of deliberations surrounding the long-running vacancy.

But he’s one of several people under consideration, and the White House has yet to formally approach him about the job, the people with knowledge of the deliberations said, cautioning that the process is still in its early stages. Emanuel told PULSE that he hasn’t been approached, but didn’t rule it out.

The Obamacare architect has solid support within the administration, including Biden’s chief medical advisor Anthony Fauci, who has backed his inclusion as a candidate to run the FDA, according to three people with knowledge of the deliberations.

And yet: In response to a request for comment, the White House said in a statement that “we have strong acting leadership in place that is playing an important role in our Covid-19 response and beyond, and look forward to sharing a nominee with the requisite expertise and leadership for this job.”

But hours after POLITICO’s article published, the White House denied that he was under consideration. “Dr. Emanuel is not in the running for this position,” spokesperson Kevin Munoz said.

JUDGE SIDES WITH CRUISE LINE ON VAX PASSPORTS — A federal judge on Sunday night sided with Norwegian Cruise Line Holdings in a high-profile fight with Florida over vaccine passports, granting the cruise line’s request for a preliminary injunction that blocks a state law barring businesses from requiring proof of vaccination.

In a nearly 60-page ruling, U.S. District Judge Kathleen Williams stated that Florida “fails to provide a valid evidentiary, factual, or legal predicate” for its prohibition on vaccine passports. This is just one of the lawsuits the governor is currently fighting over cruise ships. Florida is in another legal battle with the CDC over its cruise directive.

Background: Gov. Ron DeSantis, who has consistently fought against coronavirus restrictions such as mandates for face masks, in April signed an executive order barring vaccine passports. The Florida Legislature also approved a measure blessing the order and fining companies that violate the ban.

FAUCI URGES TESTING TO TRACK BREAKTHROUGH INFECTIONS — Biden’s chief medical advisor on Sunday pressed for more coronavirus testing be done among vaccinated people to understand the span of breakthrough Covid-19 infections, Shayna Greene reported.

Early on in the pandemic, the protocol was to test people who had been in contact with others who were infected with Covid-19 or symptomatic. Now, Fauci said on NBC’s "Meet the Press, "It’s very clear you have to go beyond that."

COLLINS CONDEMNS VACCINE POLITICS —National Institutes of Health Director Francis Collins on Sunday lamented the politicization of vaccines amid the nation's ongoing surge of Covid cases.

"We never should have let that happen. Come on, America, we can separate these. We don't need to be polarized about a virus that's killing people,” NIH Director Francis Collins said on ABC's "This Week With George Stephanopoulos.”

FDA CLEARS ASTRAZENECA DOSES FROM TROUBLED PLANTS — The agency greenlit doses of AstraZeneca’s Covid-19 vaccine for use after months of delay while it investigated contamination problems at the Baltimore plant, Emergent BioSolutions, where the shots were made.

The doses are now eligible to be shipped overseas, FDA said, but it did not specify how many out of 60 million AstraZeneca shots made by Emergent were affected by the decision. The company's vaccine has not been authorized for use in the United States.

FRONTLINE WORKERS MISSING FROM VAX MANDATES — California employers are rushing to mandate Covid-19 vaccines but so far are leaving out a key group: the essential service workers who have borne the brunt of risky conditions since the start of the pandemic, Victoria Colliver and Alexander Nieves write.

Why? Requiring vaccines is more complicated in sectors like retail and agriculture, where employers risk losing workers in a tight labor market and vaccine enforcement could be expensive. Some labor leaders who represent low-wage service workers also have pushed back against strict mandates.

But the diverging policies could widen the pandemic’s already uneven toll by leaving frontline workers, many from low-income communities of color, vulnerable to the highly contagious Delta variant.

The issue has split labor unions across the nation. Threatening layoffs or managing testing programs — is less feasible when a large share of a workforce is unvaccinated. And unlike in office settings, employers can't give warehouse, farm and grocery store employees the option of working remotely until they are vaccinated against Covid-19.

Teens struggling with long Covid describe lingering neurological, physical or psychiatric symptoms as they brace for a new school year with these challenges, New York Times’ Pam Belluck reports.

The Delta variant’s meteoric rise in the U.S. brought a jarring, premature end to a summer of relative freedom from the global viral emergency, write the Washington Post’s Joel Achenbach, Carolyn Johnson, Lena Sun and Brittany Shammas.

Another symptom of coronavirus spread: Few people are allowed beside with ICU patients, a challenge that could have a real clinical impact for fragile patients fighting to survive, writes Marion Renault in Stat News.