KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Today is June 19th also known as Juneteenth Independence Day. This marks the day in 1865 that slaves in Texas were declared free, because even though the capital of the confederacy in Richmond had fallen in April word had not yet traveled to more remote areas. And Texas had not yet officially recognized the Emancipation Proclamation, which took effect two and a half years earlier on June 1st -- on January 1st 1863. So bottom line is happy Juneteenth to you.

KOJO NNAMDILater in the broadcast, it's not science fiction. DNA found on things like a straw at a crime scene is being used to identify suspects. One Alexandria rape case recently used the method, but what are the privacy issues involved? But first there hasn't been a confirmed case of measles in the District. Yet one case was confirmed in Virginia earlier this month. And people who were exposed to the disease then might not even have symptoms yet.

NNAMDIMeasles causes a rash, a fever, and potentially lethal complications. And it is preventable with a vaccine. The only problem is that D.C. has some of the lowest measles vaccination rates in the country. The District's Department of Health is now encouraging school principals to help spread the word about the vaccine to their students and families. Could measures like this prevent an outbreak? And why are D.C.'s vaccine rates so low? Joining me in studio is Perry Stein. Perry is the Washington Post reporter covering D.C. schools. Perry, thank you very much.

PERRY STEINThanks for having me.

NNAMDIYou can find Perry's piece on the measles vaccine in D.C. schools on our social media website. Perry, what is the vaccination rate in the District and how does it compare to nearby jurisdictions in Maryland and Virginia?

STEINWell, according to the CDC when you look at kindergarteners D.C.'s vaccination rate is 81.3 percent and that's way lower than what you see in Maryland and Virginia, which have some of the higher vaccination rates at 98.6 in Maryland for that same group and 95 percent in Virginia. D.C. schools or the city officials have a little bit of different numbers, but they're all counting at different places. Theirs show, for instance, that, you know, around 92, 93 percent of public schools students have vaccines. And you see that rate a little lower for private and parochial school students.

NNAMDIWe're talking about measles, but this has come up in recent years around swine flu and other outbreaks. What's the biggest danger with measles and who's most at risk?

STEINFrom my reporting and talking to people, who are far more knowledgeable than I, you know, it can carry. It's not just a nuisance disease, is what someone told me. It's not just a cold. It can have serious complications, which can lead to death, which can lead to brain complications down the line.

NNAMDIAlso joining us in studio is Lawrence Gostin. He's a professor of Global Health at Georgetown Law and Director of the World Health Organization Center for Global Health Law. Lawrence Gostin, thank you for joining us.

LAWRENCE GOSTINThanks for having me, Kojo.

NNAMDIWhy do you think D.C.'s vaccination rate is so low?

GOSTINWell, I think it's low because D.C. hasn't done very much about it. It's got a religious exemption. It hasn't had a vaccine campaign. If you walk around the streets in D.C. you might see health messages for HIV/AIDS or something like that. But vaccines, there hasn't been a grass roots health education campaign among parents and school children to really boost it. So it really doesn't surprise me, because there's just so much misinformation out there and such low trust in vaccines.

NNAMDIPerry, why is the Department of Health asking schools to take a more active role in this conversation? Public schools already require kids to be vaccinated. So who's the target audience and how are they communicating the issue?

STEINNow the D.C. Department of Health doesn't have the authority to enforce, to make sure that every kids who isn't a public school is vaccinated. So unless there's a serious outbreak it's really up to the D.C. schools to make sure that kids are vaccinated. And we know that because there's a low vaccination rate or there are kids that we know that are not vaccinated, there must be kids at schools who are not vaccinated. So, you know, I think that D.C. is going to be pushing. This summer they have efforts to really try to do an education campaign. You know, you don't have a vaccine, no school, let's make sure parents know the importance of this.

NNAMDIWhat's an acceptable vaccination rate, so to speak, to prevent the spread of the disease?

STEINYeah, so according to Dr. Nesbitt and she's the woman, who runs the D.C. Department of Health, you know, we want to be at 95 percent. That's what she described to me as where we have herd immunity meaning that there's enough people that are vaccinated so that if there happens to be exposure we would decrease our chances for an outbreak. So she sent a letter to principals saying, Okay, we need to get above this 95 percent threshold where we are not quite there yet.

NNAMDILawrence Gostin, is this an area where word of mouth within schools can make a difference?

GOSTINWell, no. Not just casual word of mouth can make a difference, but, you know, if you think about what we've just been talking about, Kojo, if the law requires vaccination for children to be in school and we have vaccination rates so low in the District, then the mayor and the education -- and school departments need to make sure that kids are vaccinated. And, you know, if it were me -- for example, if a child wasn't vaccinated, I would check. I would go. I would talk to the parents in a non-judgmental way and try to hear what their concerns are and get the child vaccinated. That's the responsible thing to do and that's what the District needs. It's pure serendipity that we haven't had an outbreak here, because our vaccination rates are so low.

NNAMDIWhat's the legal picture here? When can parents request to be exempt from vaccinating their kids and for what reasons?

GOSTINThey can be exempt for religious reasons or if they've got genuine medical reasons, so, for example, if somebody mentioned -- if somebody was immune comprised that they wouldn't have to be vaccinated. But we need to get to 95 percent vaccination rates because what that does is that means if you get 95 percent or above, it doesn't matter if a few people aren't vaccinated because the community is protected. And, you know, we've lost this tradition, everybody it's me, me, me, me these days. We've lost the tradition of a common good where I look out for my kid, but I also look out for your kid. And if my kid is not vaccinated, I'm putting your child at risk. That's not fair.

NNAMDIWhat is the legal precedent for not vaccinating?

GOSTINWell, actually there isn't a legal precedent for not vaccinating. As early as 1905 in a very famous case Massachusetts against Jacobson, the Supreme Court ruled that it was all right to require children to be vaccinated. And later on the Supreme Court said that it was constitutional to require vaccines as a condition of school entry. So what we need to do is we need to make sure that exemptions are narrow and tight and that we enforce the law, but also that we don't regard parents as, you know, mean or misguided. You have no idea on the internet, social media the kinds of intentional misinformation campaigns that we get. So parents are confused. The very very low trust in vaccines and yet vaccines were the greatest achievement in public health in the 20th century.

NNAMDIWe know that this is a contentious issue. So I want to emphasize today that we're focusing on the rates of vaccination and some of the legal issues rather than the thorny issues and I guess really controversial issues about people, who are suspicious of vaccines.

GOSTINBut I should say it's very important to say that the science is very clear that vaccines are very effective with extraordinarily rare adverse effects.

NNAMDIA tweet from WrongWrong Right, who says, I'm worried. I am adopting a baby from out of state and we will have to travel with that baby back home as early as two weeks old. So obviously our tweeter wants more people to get vaccination. Perry, does the vaccination data among schools reflect the idea that there are certain communities not vaccinating more than others?

STEINYou know, Dr. Nesbitt in an interview with me, she told me that she hasn't really seen trends to suggest that, you know, this community isn't getting vaccinated or this one is in D.C. specifically. I mean, you can see schools in some of the most low income neighborhoods with the highest vaccination rates, same with some of the schools in the wealthiest neighborhoods. You do see and what I did see a couple very small religious affiliated schools having low vaccination rates.

STEINNow I don't know what that is a result of, there's nothing really within the religions that I found that would suggest, hey these religions are against vaccines. So it could be a number of things. I mean, they have really small schools. So, you know, if they have 20 kids and a few kids aren't vaccinated, the results would look very different than a school with 400 kids. But there could also be the potential of just bad information keeping.

STEINYou know, I called one school when I saw their vaccination rates that were low and they said, oh, ours are much higher, and said, there must be a mistake in this data. I don't know if that's true, but I heard from a number of experts that some of the particularly low rates could be a result of bad information keeping.

GOSTINAnd so could the high rates.

STEINAnd so could the high rates too.

GOSTINIf you've got bad information it's just bad and it shouldn't be bad.

NNAMDIWhat percentage of kids not vaccinated are we talking about?

STEINI mean, I saw a few kids. The D.C. Department of Health has now publicized its school vaccination rate data. And there were a couple of schools that were in the 30 percent range. You know, I did not talk to them for this article. I, obviously tried to, but their rates are extraordinarily low. You see some charter schools even in the 60 or 70 percents.

NNAMDIKids aren't allowed to attend school without having proof of vaccination unless they do have that waiver, but you note that the rules are not always enforced.

STEINThat seems to be clear. I mean, I did a public record request of the exemptions in the public schools and, you know, there's only 152 D.C. traditional public and charter school children, I believe that of about 100,000, who have religious exemptions and only 32 with medical exemptions. So our data suggests there are more than just these kids that do not have vaccines.

NNAMDILawrence Gostin, is our region in general prepared to prevent a measles or other outbreak more broadly?

GOSTINNo. We're not. I mean, I think we've just been hearing that. First of all, we don't have good surveillance data. We shouldn't be speculating with well-informed people about what rates are, where potential weaknesses are, because you've got very very low vaccination rates. I mean, the District of Columbia, given the fact that it has such low overall vaccination rates has to be worried, because you saw this happening in New York City where you had outbreaks among schools that had similarly low vaccination rates. You saw it in L.A.

GOSTINAnd I should say it's not just our school children, we've got a lot of major universities here and universities are the hotbeds for the spread of infectious diseases like happened in UCLA. And so we need to do a lot more to be able to get our handle on the problem and get our vaccination rates uniformly up to 95 percent or higher.

NNAMDIHere now is Sarah in Silver Spring, Maryland. Sarah, you're on the air. Go ahead, please.

SARAHI have two suggestions for officials, who would like to improve vaccination rates. The first is a repeal of the federal 1986 National Childhood Vaccine Injury Act, which removed liability from pharmaceutical companies for their vaccine products on the childhood schedule. And the second would be to listen to the consumers of vaccine products. One thing that I would love to see is the separation of the MMR. A lot of parents would like to give a single antigen measles vaccine. And so I really question if we really want to see measles vaccination why we can't offer those things to parents.

NNAMDILawrence Gostin.

GOSTINYeah. Unfortunately I disagree with both of those suggestions. Let me explain why. The National Vaccine Compensation Act has been very widely regarded as a success, because by creating liability on vaccine companies what you do is you dis-incentivize. And what we need to do is get them to do more vaccines. These vaccines are very very safe and what these compensation boards do is if you happen to have an adverse result, which is very very rare, it will compensate you irrespective of fault. And then separating the MMR vaccine, the MMR has been widely regarded as safe and effective. There are no scientific evidence that I'm aware of at all that suggests that it needs to be separated or that it would be wise to separate.

GOSTINOur own health agencies in the District of Columbia, the Centers for Disease Control and Prevention all have, you know, full trust and faith in the MMR. And we should. It's one of the most studied medical products in the history of the world. And it's been shown to be highly effective and extraordinarily safe.

NNAMDII want to address the issues of exemption. Here's first Greta in Stafford, Virginia. Greta, you're on the air. Go ahead, please.

GRETAHi, Kojo. I just wanted to get everyone's reaction to the SB276 Bill going on in California trying to dial back on fake medical exemptions from those who doctor shop and try to come up with reasons to get their kids out of vaccines.

NNAMDIAnd I know California does not allow religious exemptions; is that correct?

GOSTINNo, it doesn't. And New York State just also banned religious exemptions. Yes. I actually think the reason for this bill, which it may not pass, because the governor may not sign it. But the reason for this bill is that when there was a big measles epidemic in Disneyland a number of years ago, the state then took away all non-medical exemptions. And when it did that, the rate of medical exemptions started rising worryingly so. And so it turns out you've got some doctors, who are either lax or unscrupulous that are giving medical vaccinations exemptions when they shouldn't. And all this law does if it were to be enacted is to make sure that medical exemptions conform with the CDC's definition of a valid medical exemption.

NNAMDIThank you for your call, Greta. Drew in Fairfax also wants to talk about exemptions. Drew, you're on the air. Go ahead, please.

DREWHi, Kojo. Quick background. I have a medical exemption for a vaccine that is contraindicated with a chronic illness I have. And there is two questions I have. Is there a way that, I guess, companies, schools, and organizations cannot over react to the anti-vaccine movement by recognizing that some medical exemptions are legitimate. Since working in healthcare, it's sometimes hard to find work, because of medical exemptions for vaccines. And two should -- is there a way that physicians can hold other physicians accountable for not vaccinating their patients that are perfectly healthy despite literature showing that vaccines are very good for the health or our community? Thank you.

NNAMDILawrence Gostin.

GOSTINYou know, you should not feel at all ashamed or concerned that you have a valid medical exemption. It's completely all right. And your employers and colleagues should all respect that. In fact, the famous Supreme Court case I talked about made absolutely clear that it would be unconstitutional to require somebody with the a valid medical exemption to be vaccinated. So that should not be an issue.

GOSTINHolding doctors accountable is a different thing. I don't think there's any way for one doctor to hold another doctor accountable except by, you know, peer discussion and peer review. But the Health Department can do that and I think they should, just like you wouldn't want a doctor to commit Medicare or Medicaid fraud. And we would investigate that. If doctors are wrongly issuing medical exemptions to healthy people that puts the entire community at risk and really shouldn't be acceptable.

NNAMDIDrew, thank you for your call. Before we go, Perry Stein, any idea how school principals are responding so far to the Department of Health's initiative?

STEINYou know, I really don't. I think the initiative and this kind of increased awareness is kind of just kicking off. So it will interesting to see what happens this summer and if, you know, the preschool students or the kindergarteners, they come with more education and a higher vaccination rate this, you know, this upcoming school year.

NNAMDII'm depending on you to keep us posted.

STEINI will.

NNAMDIPerry Stein, she's the Washington Post reporter covering D.C. schools. You can find her piece on the measles vaccine in D.C. schools on our social media or on our website. Perry, thank you so much for joining us.

STEINThanks so much for having me.

NNAMDILawrence Gostin is a professor of Global Health at Georgetown Law and Director of the World Health Organization Center for Global Health Law. Thank you for joining us.

GOSTINThanks for having me.

NNAMDIGoing to take a short break. When we come back, DNA found from websites that deal with people, who submit DNA being used to track down criminals. Is that a violation of privacy? We'll discuss that after this short break. I'm Kojo Nnamdi.