This summer, the American Red Cross declared an emergency blood shortage in the U.S. There’s a seasonal pattern to blood donations, which often dip over the summer and during the winter holidays. But experts also say that climate change disrupts the national blood supply, with extreme heat and worsening storms in certain regions keeping people away from blood banks.
“The shortage is not over,” Adm. Rachel Levine, the assistant secretary for health at the Department of Health and Human Services, said to STAT, noting that shortages happen periodically. As of Monday, 28 out of 59 community blood centers operated by America’s Blood Centers had just a one-to-two-day supply of blood. Nine centers had less than a day’s worth. It takes at least three days’ worth of supply to meet normal operating demands, according to the organization, which provides more than half of the U.S. blood supply.
“The only way to solve this is more donations,” Levine added. “There’s no other way that we can get red blood cells and platelets and plasma.”
Levine’s office is working to raise awareness of the importance of blood donation and the threat that climate change poses to health more broadly. But some have argued that HHS — and particularly the Office of Climate Change and Health Equity, which is under Levine’s purview — has not done enough to protect public health in the face of climate change.
In a conversation with STAT, Levine responded to that criticism. She also provided an update on the blood shortage and spoke about the politicization of gender-affirming care for youth. Facing climate change and restrictions on health care like gender services and abortion, Levine remains “a positive and optimistic person,” she said.
The conversation has been edited for length and clarity.
The American Red Cross announced a blood shortage this summer. Was that more acute compared to normal seasonal trends?
I think that it was more acute this year. There are significant challenges in terms of the nation’s blood supply during and coming out of the acute phase of the Covid-19 pandemic. We’re out of the acute phase of the pandemic but challenges continue. A steady, predictable blood supply is just essential to the public health of our nation. There are so many acute and chronic life-threatening conditions that are treated with blood. The statistic is every two seconds, someone in the United States needs blood.
The American Red Cross said part of the problem was due to extreme heat affecting blood drives. Can you talk about how climate change can affect blood shortages?
People tend to stay at home and in air conditioning if it’s available during extreme heat. And climate change has a significant impact upon human health that we are learning more and more about.
I have been around the country and seen the impacts of extreme heat. So I was in Orlando, Florida, and had a roundtable with migrant farm workers. And what the farm workers say is that they leave their kidneys in the field. They leave their kidneys in the field because of extreme heat on the farms and dehydration.
When you talk about farm workers leaving their kidneys in the field, it’s clear how that is a health issue. But if you think about some of the possible solutions — things like worker protections — they don’t often fall under the purview of health agencies or health policy. What needs to be done to protect people from the health effects of climate change?
We all need to work together. We have an Office of Climate Change and Health Equity that we affectionately call “Ochie.” It’s a small but mighty office, and we work with our partners at HHS. We work with the Centers for Disease Control and Prevention, we work with the Agency for Toxic Substances and Disease Registry office, which is at CDC. In terms of preparedness, we work with the Centers for Medicare and Medicaid, we work with the Environmental Protection Agency. We work with the National Institute for Occupational Safety and Health and with the Occupational Safety and Health Administration at the Department of Labor because they do set the rules in terms of worker health. We work across the federal government on these issues and the impacts of climate change on health.
We also work on the health sector — the United States health sector accounts for 8.5% of carbon emissions. And so we need to work to develop resilience to the impacts of climate change and work to decarbonize.
Over the summer, STAT published an opinion essay that argued HHS has been “climate washing,” meaning that the agency has been providing inadequate information or has been misleading about its climate policy ambitions. The piece specifically cited how the Office of Climate Change and Health Equity has yet to be funded, and that it hasn’t specifically pursued regulatory action to reduce health care industry emissions. Do you have a response to that criticism?
OCCHE, as you said, is unfunded. And my office of the assistant secretary for health doesn’t have regulatory authority about these issues, but we do work really closely with others that do. They are working on carrots more than sticks. They are working through the [CMS] Innovation Center on incentives to work on this. We have not looked to punitive penalties or anything like that. So I would respectfully disagree with the article, I think we’re doing a great job.
It is in the ’25 budget. The ’26 budget hasn’t been released by the White House but I fully expect it to be in the ’26 budget. And hope springs eternal that Congress will fund the office so we can do even more work. In the end, I’m a positive and optimistic person and I think we’ll be successful. And I think that right now incentives are better than penalties.
Last year, the Food and Drug Administration put out new guidelines for blood donations so more gay men and queer people who are monogamous can donate blood. What sort of reactions to that have you seen, and have there been any clear effects in terms of donations?
We have seen tremendous support from the blood donation community. We do not have statistics yet about rates of donation among different populations. But all the reaction has been extremely positive to this necessary step.
Do you think there will ever be a world in which people with multiple sexual partners could donate blood safely and regularly?
It’s hard for me to predict the future. So we will see in the future how things go and how this implementation goes in terms of numbers.
The first time you and I spoke was at the Boston Alliance of LGBTQ+ Youth almost two years ago. You spoke about how trans and queer people are supported at the “highest levels” of government. Since then, President Biden has tried to expand anti-discrimination protections in the Affordable Care Act for trans people, but a federal judge blocked those protections from going into effect. This fall, the Supreme Court will hear an appeal from the Biden administration on state bans of gender-affirming care. What are your thoughts on how trans people, and particularly their access to gender-affirming care, have become such a major political issue in recent years, and particularly during this election cycle?
We tend to look at the social determinants of health — those factors that influence health that aren’t directly medical-related. The actual legal and political structure of the state that you live in is itself now a social determinant of health. And that is true in terms of access to transgender medicine services, gender-affirming care. And it’s true in terms of the full range of reproductive rights that we see in our nation, including abortion. We have medical refugees in the United States who have to leave their state to get the care that they need and deserve.
I’m going to remain a positive and optimistic person. I think that these efforts will not be successful and the wheel will turn. But I’ve traveled throughout the country. I have seen the impacts of these laws on trans youth, on their families, on their medical providers.
You’re a pediatrician by training. Are there misconceptions about the way gender-affirming care is provided to youth that you want to explain to people?
Gender-affirming care is an evidence-based, standard-of-care medicine that evolves over time, the way all standards of care evolve over time. If you have a child with a heart condition, then you would see the pediatric cardiologist at the children’s hospital. If you have a child with a psychiatric condition, you would see the child or adolescent psychiatrist or psychologist at that hospital. If you had a child with diabetes, you would see the pediatric endocrinologist at that hospital. So why are we contacting the state legislature when you have a child with gender issues?
The idea is that you would see the gender specialist and the team at the children’s hospital, which are often the exact same people. It’s the same pediatric endocrinologist. It’s the same child and adolescent psychiatrist. These laws and actions are getting in between a physician and his or her team, often at a children’s hospital, and parents and the young person.