Q&A: Assistant Secretary for Health talks community-based public health and COVID-19

On June 11, The Stanford Daily sat down with Rachel L. Levine, Assistant Secretary for Health at the U.S. Department of Health and Human Services, to reflect on her experiences combating the COVID-19 pandemic. Levine was nominated by the Biden Administration in February, 2021 and was confirmed in March. During this year’s Pride Month, Levine — the first openly transgender official confirmed by the Senate — spoke to the Stanford Department of Pediatrics about the pediatric disparities and unequal opportunities that LGBTQ+ youth face. On June 11, she also attended the 35th anniversary display of the AIDS Memorial Quilt at San Francisco’s Golden Gate Park, recounting the deaths inflicted by the AIDS/HIV epidemic that she witnessed firsthand as a pediatrician in 1983.

This interview has been lightly edited for clarity.

The Stanford Daily [TSD]: What are some lessons that you learned from handling the COVID-19 pandemic?

Rachel L. Levine [RL]:  I think that there are some clear lessons. One of them is that we are truly all interconnected. Literally, the decisions that each one of us make about our health, whether that’s to get tested or to get vaccinated, impact not only ourselves, but they impact our communities, our families. They impact our nation and they literally impact the world. We are all truly interconnected in so many ways.

Another lesson of the pandemic is the importance of public health. And public health sometimes gets lost in the general medical structure that we have in our medical health systems. But public health at the local, state, federal and international level is really critical for the health of our world and our nation and critical to our response to this pandemic. I used to say that cities like San Francisco were the center of the universe, but actually public health is the center of our universe. It’s that important. 

TSD: What is the importance of community-based organizations to expand health access to minority groups?

RL: Health equity is so critical to our work in public health. And of course, I’m at the United States Department of Health and Human Services (HHS), where our secretary Xavier Becerra’s priority is that we embed health equity into all of our different work. Health equity has to be the foundation. We can work on that federally, but actually, I think that some of the most important work is community work. I’ll come and visit your community, but I’m not there day by day. 

And so, community health workers, advocates and health and medical workers really are the frontlines on how we bring health equity to many vulnerable, marginalized populations. That, of course, includes the African American community, the Latino community, the American Indian Native Alaskan community, the AAPI (Asian American Pacific Islander) community and our LGBTQI+ community — there are so many intersections among those communities. So we really appreciate and depend on community health workers, community organizers and stakeholders to do that work.

TSD: What is the federal government doing to aid people who have long COVID, and are there any solutions on the horizon?

RL: Absolutely. Long COVID is going to be one of the medical challenges of our future — our present and our future. The president recognizes that, and he has issued a presidential memorandum asking for two reports, one on the supports and services for patients who have long COVID and the other the National Research Action Plan on Long COVID. My office is coordinating the writing of those reports. We are the lead. I want to acknowledge so many people across the Department of Health and Human Services (HHS) and across the administration that are contributing to that report. We need to involve the entire medical community and our primary care doctors in that long COVID work. And then we need to work on the research agenda which is being led by NIH and CDC, such as the RECOVER and INSPIRE grants, and across the HHS.

I want to acknowledge specifically the work from the VA and the Department of Defense, both on their research as well as their works in terms of supports and services. And we’re going to develop that action plan. Now, the reports are the beginning: we don’t write the report and go to bed. That is the roadmap to these living documents and this living plan about how we’re going to help people with long COVID. I think you need to take the lessons learned from the HIV epidemic and from COVID-19 itself. We will also develop these programs by taking the lessons we’ve learned dealing with chronic illnesses like ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) and Lyme disease. So that is going to be one of the things that I’m going to concentrate on during my time at HHS.