Admiral Rachel L. Levine, a pediatrician by training, led the Public Health Service during the Biden administration. She is pictured in a conference room at HHS headquarters in Washington, D.C.
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In 2021, the country had one state banning gender-affirming care for young people: Arkansas. In March of that year, Dr. Rachel Levine won Senate confirmation to lead the United States Public Health Service Commissioned Corps as assistant secretary of health. She has the rank of admiral.
Levine is the highest-ranking transgender person ever to serve in the federal government.
In the nearly four years that she has worked at the Department of Health and Human Services, anti-trans legislation has exploded. Twenty-five other states followed Arkansas in banning gender-affirming care for young people. Other laws focus on the use of restrooms in schools and public buildings, or prohibit transgender children from participating in sports corresponding to their gender identity.
In the final days of the presidential campaign, Republicans used Levine’s image in “Kamala is for Them” ads that — some experts say — helped Republicans win the presidency and both houses of Congress.
Discreet and pragmatic
All this time, Levine worked, somewhat quietly, at HHS in Washington, DC. She sat down with NPR for an exit interview in late December. She has a friendly, discreet personality and a pragmatic sensitivity. She loves Joni Mitchell and she brings her lunch from home – today it’s a turkey wrap.
She is a pediatrician specializing in adolescent medicine who was in charge of public health in Pennsylvania before being nominated to serve in the Biden administration. She wears the blue woolen uniform of the Public Health Servicewhich is the branch of the uniformed services that she leads.
Levine was excited about a new campaign promoting childhood vaccines called “Let’s be realisticDeclining childhood vaccination rates is one of the challenges she has tried to address in her role. She is aware that the new Trump administration is poised to hand over leadership of HHS to anti-vaccine activists .
Can this effort last more than a few weeks? “It’s impossible for me to say what will happen after the inauguration,” she said. “This campaign has been planned for over a year; it’s coming out now.”
An eyewitness to the benefits of vaccines
She seems fearless. Vaccines are incredible, she continues, and explains how she witnessed them firsthand.
“I started my pediatric residency program at Mount Sinai Hospital in New York in 1983,” she says. This was before the release of the HiB vaccine, which protects against a bacteria called Haemophilus Influenzae Type B. “We used to see so many children with very serious bacterial infections from this bacteria – pneumonia, meningitis, sepsis. And after the vaccines came out and were given for several years, we really don’t see these infections anymore .
The HIB vaccine is a vaccine that is rarely talked about, Levine says, because she has seen very serious infections in infants eliminated during her career.
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“Of course, pediatricians in training have never seen it, but I have seen it,” she says. “This is an example of a vaccine that doesn’t get talked about much, but we have virtually eradicated this serious infection in the children I was caring for in the hospital with this vaccine. And this is just one example of so many others.”
That’s the essence of his job: explaining enthusiastically and clearly why public health measures are important. She speaks proudly of her office’s efforts on climate change, the HIV epidemic, and food is medicine initiatives. Policies will surely change under Trump’s nomination, but she believes the public health work will continue. “We have extraordinary public servants here,” she said.
As part of his role, Levine traveled the country, visiting local health departments and organizations. She talks about a migrant farm worker she met in Orlando, Florida, and an Arctic island she visited in Alaska. During her journey, she was likely the first transgender person many of the people she met had ever met.
“I am a resilient person and I am doing well”
She generally doesn’t talk much about her transgender identity. She was born in 1957 and attended an all-male prep school outside of Boston, which was “obviously a very interesting experience,” she says. “Remember, this is the early 70s – I obviously had feelings about my gender, but what were you going to say and who were you going to say it to?”
She came out as transgender decades later. “I think for anyone to have a secret is not a healthy thing,” she says. “I think transitioning, coming out of the closet and becoming my true authentic self liberated me. It was an incredible experience.”
Admiral Rachel L. Levine, MD, Assistant Secretary for Health, maintains an awards wall in front of her office in Washington, DC.
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Levine has been targeted by right-wing media, sometimes simply because she is trans, but also for her support of gender-affirming care.
She ignores the fact that her image was used in the anti-trans ads that dominated the final weeks of the presidential campaign. “It was very difficult, but I am a resilient person and I am doing well.”
She told NPR in 2022 that “there is no debate among health professionals (…) about the value and importance of gender-affirming care.” Since then, some high-profile medical professionals have called for caution in this medical area, including British pediatrician Hilary Cass. These doctors are often cited by lawmakers seeking to ban this treatment. Cass was mentioned recently during arguments before the Supreme Court over whether such bans were constitutional.
“There is still broad consensus about the medical utility of transgender medicine and transgender medicine for young people,” Levine says. “Research is always underway to study any of our medical protocols, and that would include transgender medicine. We should always have in-depth discussions and analyzes of our treatment protocols, and they must be data-driven. “
She says these standards of care should then be carefully applied to each patient. “This is how we do pediatrics and this is how it should be done,” she says.
It has nothing to do with the proliferation of state anti-trans laws, she said. “This is actually a politically and ideologically motivated effort developed by a think tank in Washington to attack the LGBTQI+ community, starting with the trans community,” she says. “And unfortunately, it was very successful.”
She says she chooses to be optimistic and believes things will get better for trans people in the United States.
Levine will resign on Inauguration Day. She says she’s going to return to central Pennsylvania, take a vacation and plan her next steps.
A detail of the exhibit outside Admiral Levine’s office in the Humphrey Building, home to the Department of Health and Human Services headquarters in Washington, DC.
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