A Q&A with Admiral Rachel Levine, Pennsylvania’s former Secretary of Health

Admiral Rachel Levine’s path to the U.S. Department of Health and Human Services was anything but direct. Specializing in pediatrics and psychiatry coming out of the Penn State College of Medicine, Levine went on to serve as Pennsylvania physician general before she was appointed Secretary of Health in 2018 by former Gov. Tom Wolf, where she spearheaded the administration’s response to the COVID-19 pandemic. 

Levine, now the U.S. assistant secretary for health, recently spoke with City & State about her work at HHS, including efforts to combat the opioid epidemic, past and present initiatives surrounding COVID-19 and recent state measures that support LGBTQ+ youth. 

This interview has been edited and condensed for length and clarity. 

What does your new role entail and how has the work changed from the state to the federal level? 

I’m the senior advisor to the secretary of health on medical and public health issues and work really closely with the secretary’s office and all the other divisions of HHS. I'm also the leader of the U.S. Public Health Service Commissioned Corps and work with the surgeon general to lead almost 6,000 medical and public health officers that work across the United States. We provide medical care, for example, for many sites of the Indian Health Service, the Federal Bureau of Prisons and other areas. 

In fact, several of our officers are part of the Centers for Disease Control and Prevention’s response to the train derailment in Ohio. It’s a tremendous honor and tremendous opportunity … We are the conveners and consultants about many, many different public health issues. 

What do your day-to-day operations look like? 

I meet regularly with all the different division heads at HHS. I have a lot of public speaking events. I was in Kutztown (earlier this month). We work really closely with the National Academy of Medicine, which I’m a proud member of now, and we work on climate change, health, health equity of the overdose and opioid crisis and many other things … It’s lots of speaking with stakeholders, not that much different than what I did in Pennsylvania, but of course, we have a national perspective. 

Can you talk about your work related to the opioid crisis and what you call the ‘four pillars’ of HHS’ strategy?

Primary prevention, harm reduction, evidence-based treatment and recovery supports: those are the four pillars of the overdose prevention strategy at HHS. 

We have made a lot of progress in terms of preventing the overprescription of opioids for pain and chronic pain, but there's still more work to do … We want to emphasize harm reduction. One tenet of harm reduction that I have been working on throughout my career is the distribution and administration of the life-saving medicine Naloxone. I wrote the first statewide standing order regarding Naloxone when I was in Pennsylvania, so we are still working to make sure that we really blanket the country with Naloxone. (It) is critically important because if there's life, there's hope. I’ve said before that you can’t have somebody go into treatment and recovery if they're dead. The Food and Drug Administration just recently had a discussion about making Naloxone over the counter. 

Another important harm reduction is fentanyl test strips. Two-thirds of the overdose deaths that we see involve synthetic fentanyl compound, which comes in through Mexico. We want to have people who have the disease of addiction be able to use fentanyl test strips so they can take precautions with what they’re taking … There are so many pills pouring into the U.S. that look like Adderall, Xanax or other pharmaceuticals, but when people buy them illicitly thinking they're getting those drugs, what they're getting is fentanyl and they overdose. 

You’ve spoken about long COVID at public events. Can you talk about its prevalence and how it affects people? 

Even as the public health emergency ends, we’re going to be dealing with COVID-19 and its long-term impacts. One of the most important messages I want to get across is long COVID is real. It might not be one thing. There might be different aspects of long COVID and different classifications, so we are working on those definitions with the National Institutes of Health, CDC, as well as the National Academy of Sciences, Engineering, and Medicine. 

We work closely with the secretary's office, and we work closely with the White House, coordinating and collaborating – playing that connective tissue role – about long COVID. 

It is something that we need to talk about and it is something that we need to make sure that physicians and other medical providers understand is a real condition. We don't have specific treatments yet, but we do know several things. For example, we know that if you are immunized against COVID-19 you have a lower chance of getting long COVID. 

Former Gov. Tom Wolf said that COVID-19 caught everyone flat-footed. Can you talk about the emergency tabletop exercises the administration went through and some lessons learned looking back now at your response? 

I would like to commend Governor Wolf for his two terms and the work that he did on education, but also his work in terms of medical issues and public health issues. I always said public health preparedness was one of my top three priorities because it could be the risk of a global pandemic, and unfortunately, that was prescient. 

We had tabletops. The federal government had tabletops as well. But I don’t think we quite understood the scale and scope of the global pandemic and it was a challenge internationally, and obviously for the federal, state and local governments. I think that the lessons learned from the pandemic is the critical importance of public health, which is traditionally underfunded. 

I think that public health (officials) at the federal, state and local levels need to work closer together … We have fantastic medical countermeasures. We have safe and effective vaccines, boosters and updates. But we are facing tremendous disinformation and misinformation about public health and vaccines, which is a real challenge for us as we prepare for any future challenges.

What are your thoughts on the content and book bans some state school districts are implementing, particularly related to transgender topics?

Health equity is absolutely critical to deal with disparities in our nation, that includes the LGBTQ+ community, which suffers significant health disparities. We have made progress, but we haven’t made true progress unless it’s progress for everyone. And the particular groups that continue to really suffer are LGBTQ+ people of color, native and Alaskan groups, seniors, immigrants, but also youth. There are a lot of state actions and laws that are targeting vulnerable trans and gender non-binary youth. Those youth have an increased rate of mental health issues, such as depression and anxiety. It’s the bullying, harassment and discrimination they face that leads to those negative health outcomes, and now in many states, it is being state-sponsored.