This summer, the American Red Cross declared an emergency blood shortage in the US. Blood donations show a seasonal pattern, often decreasing during the summer and winter holidays. But experts also say climate change is disrupting the national blood supply, with extreme heat and worsening storms in certain regions keeping people away from blood banks.
“The shortage is not over,” Admiral Rachel Levine, the assistant secretary of health at the Department of Health and Human Services, told STAT, noting that shortages occur periodically. As of Monday, 28 of the 59 community blood centers were operated by American Blood Centers only had a one to two day supply of blood. Nine centers had less than a daily value. According to the organization, which provides more than half of the U.S. blood supply, at least three days’ supply is needed to meet normal operational demand.
“The only way to solve this is more donations,” Levine added. “There is no other way we can get red blood cells, platelets and plasma.”
Levine’s office works to raise awareness of the importance of blood donation and the threat climate change poses to broader health. But some have argued that HHS — and especially the Office of Climate Change and Health Equity, which falls 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 young people. Faced with climate change and restrictions on health care such as 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 it was more acute this year. There are significant challenges facing the country’s blood supply during and after the acute phase of the Covid-19 pandemic. We are out of the acute phase of the pandemic, but challenges remain. A stable, predictable blood supply is essential to our nation’s public health. There are so many acute and chronic life-threatening conditions that are treated with blood. The statistic is that every two seconds someone in the United States needs blood.
The American Red Cross said part of the problem was due to the extreme heat affecting blood supply. Can you talk about how climate change could affect blood shortages?
People tend to stay home and stay in air conditioning if it is available during extreme heat. And climate change has a significant impact on human health, which we are learning more and more about.
I’ve been all over the country and seen the effects of extreme heat. So I was in Orlando, Florida, having a roundtable discussion with migrant farmworkers. And what the farm workers say is that they leave their kidneys in the field. They leave their kidneys in the fields because of the extreme heat on the farms and dehydration.
When you talk about farm workers leaving their kidneys in the field, it’s clear that this is a health problem. But if you think about some of the possible solutions – things like protection of workers – they do not often fall under the purview of health authorities or health policy. What needs to be done to protect people from the health effects of climate change?
We all have 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. On 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 the Department of Labor’s Occupational Safety and Health Administration because they set the rules for worker health. We are working across the federal government on these issues and the health impacts of climate change.
We are also working on the healthcare sector: the healthcare sector in the United States is responsible for 8.5% of CO2 emissions. And so we must work to develop resilience to the impacts of climate change and decarbonize.
Over the summer, STAT published an opinion essay arguing that HHS “climate washing”, meaning that the agency has provided insufficient information or been misleading about its climate policy ambitions. The piece specifically notes that the Office of Climate Change and Health Equity has yet to be funded, and that it has not specifically taken regulatory action to reduce emissions from the healthcare sector. Do you have a response to that criticism?
OCCHE, as you said, has no funding. And my office of the Assistant Secretary of Health does not have regulatory authority over these issues, but we do work very closely with others who do. They work more with carrots than with sticks. They work through the [CMS] Innovation Center about incentives to work on this. We didn’t look at penalties or anything like that. So I respectfully disagree with the article, I think we are doing an excellent job.
It’s in the ’25 budget. The ’26 budget has not yet been released by the White House, but I fully expect it to be in the ’26 budget. And the eternal hope that Congress will fund the office so we can do even more work. Ultimately, I am a positive and optimistic person and I think we will be successful. And I think incentives are better than punishment right now.
Last year, the Food and Drug Administration issued new blood donation guidelines so that more gay men and gay people who are monogamous can donate blood. What reactions have you seen to this and are there any clear effects in terms of donations?
We have seen tremendous support from the blood donation community. We do not yet have statistics on donation rates among different population groups. But all reactions to this necessary step were extremely positive.
Do you think there will ever be a world where people with multiple sexual partners can 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 figures.
The first time you and I spoke was almost two years ago at the Boston Alliance of LGBTQ+ Youth. You talked about how trans and queer people are supported on the “highest levels” from the government. Since then, President Biden has tried to expand anti-discrimination protections in the Affordable Care Act for transgender people, but a federal judge blocked these protective measures will not come into effect. The Supreme Court will make a ruling this fall appeal from the Biden administration on state bans on gender-affirming care. What are your thoughts on how transgender people, and especially their access to gender-affirming care, have become such a major political issue in recent years, and especially during this election cycle?
We tend to look at the social determinants of health – the factors that influence health that are not directly medically related. The actual legal and political structure of the state you live in is now itself a social determinant of health. And that includes access to transgender medicine services and gender-affirming care. And that includes the full range of reproductive rights we see in our country, including abortion. We have medical refugees in the United States who must leave their states to get the care they need and deserve.
I remain a positive and optimistic person. I think these efforts will not be successful and the wheel will start turning. But I’ve traveled all over the country. I have seen the impact of these laws on trans youth, on their families, on their medical providers.
You are a pediatrician by training. Are there any misconceptions about the way gender-affirming care is delivered to young people that you would like to explain to people?
Gender-affirming care is an evidence-based standard of care that evolves over time, as all standards of care evolve over time. If you have a child with a heart condition, you will go to the pediatric cardiologist at the children’s hospital. If you have a child with a psychiatric condition, you should visit the child or adolescent psychiatrist or psychologist at that hospital. If you had a child with diabetes, you would go to that hospital to see the pediatric endocrinologist. So why do we contact the state legislature if you have a child with gender issues?
The idea is that you see the gender specialist and the team at the children’s hospital, often they are the same people. It’s the same pediatric endocrinologist. It’s the same child and adolescent psychiatrist. These laws and actions come between a doctor and his or her team, often in a children’s hospital, and parents and the young person.