New research on weakened COVID-19 vaccine responses in people with obesity and diabetes is the featured study in the latest issue of , conducted by the University of �鶹��ý at Mānoa’s (JABSOM), accompanied by cover art from a post-doctoral fellow.

The study, led by JABSOM third year medical student Brent Fujimoto and PhD alumna Olivia Smith in Professor Axel Lehrer’s lab, examines how different COVID-19 vaccines perform in individuals with obesity and diabetes—two conditions that increase vulnerability to the virus. Brien Haun, a postdoc fellow at Kapiʻolani CC, also contributed to the research and designed the cover art.

Funded by the Victoria S. and Bradley L. Geist Foundation via the �鶹��ý Community Foundation, the study tested vaccine responses in mice with obesity and Type 1 and Type 2 diabetes. Results showed that all three conditions weakened immune responses post-vaccination, particularly in diabetic mice. However, mRNA vaccines produced strong antibody responses in all cases. Additionally, an enhanced protein vaccine developed at JABSOM (adjuvanted subunit vaccine) helped boost antibody strength in obese and diabetic mice.

mRNA vaccines remain highly effective, but people with obesity or diabetes may need additional doses or tailored interventions to enhance immune protection.
—Brent Fujimoto

“This shows us that mRNA vaccines can still be good at blocking virus responses and the CoVaccine adjuvanted subunit vaccine (enhanced protein vaccine) helps strengthen the quality of antibodies in obese and diabetic mice, making them better at recognizing and attaching to the virus,” said Smith.

Fujimoto emphasized the real-world impact. “mRNA vaccines remain highly effective, but people with obesity or diabetes may need additional doses or tailored interventions to enhance immune protection.”

Haun’s cover art, inspired by Zen philosophy and the Roman god Janus (god of beginnings and endings, gates and doors), symbolizes the delicate balance between resilience and fragility in immune responses.

“I’m so proud that our collaborative efforts in the middle of the Pacific are not only advancing our understanding of the virus, but it’s also earned us a spot on the cover of COVID,” Lehrer said. “These are achievements we can all be proud of and it’s a testament to the power of teamwork in research.”

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Since HIV was linked to AIDS in 1983, researchers have struggled to develop a vaccine due to the virus’s rapid mutation, which makes it difficult to create an immune response that can prevent infection. Iain MacPherson, assistant professor at the University of �鶹��ý at Mānoa’s (JABSOM), is tackling this problem with a promising new approach. He recently received a $410,813 grant from the National Institutes of Health to develop a vaccine targeting a stable part of the virus.

“Developing an HIV vaccine is one of the most difficult, complex problems in medicine,” MacPherson said. “We’re aiming to engineer an immunogen better capable of protecting people against diverse strains of HIV so we can help stem the spread of HIV.”

MacPherson explained that HIV’s rapid mutations make vaccine development tough. Researchers are focusing on a stable region of the virus’s spike protein to create broadly neutralizing antibodies (bnAbs) that can fight multiple strains of the virus.

“If an antibody can bind to that part of the HIV spike protein, it would block the interaction, neutralize the virus, and prevent it from being able to infect someone,” MacPherson said.

More effective vaccine design

MacPherson’s research focuses on accelerating the production of these bnAbs by targeting specific B-cells. The new vaccine design aims to direct the immune system to target specific B-cells that can produce a key antibody, helping them develop it more effectively.

Working with JABSOM Professor Axel Lehrer, MacPherson is using molecular engineering and AI tools to test the vaccine design on humanized mouse models. If successful, the approach could improve vaccines for other viruses like influenza and COVID-19.

A �鶹��ý native, MacPherson began HIV vaccine research during his postdoctoral studies and joined UH in 2017.

“There’s been a lot of amazing work done in HIV vaccine development and we’re hoping that we can contribute part of the solution to the HIV vaccine problem,” he said.

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With �鶹��ý’s first confirmed cases of avian influenza (H5N1), it is important for residents to stay informed about the virus’s potential impact on both animal populations and human health. Although the immediate risk to humans is low, understanding the nature of the virus, its transmission, and how to take preventive measures remains crucial to ensuring public safety and minimizing its spread.

Axel Lehrer, a professor of tropical medicine and medical microbiology at the University of �鶹��ý at Mānoa’s , educates and trains the next generation of biomedical professionals and is project lead on the recombinant Filovirus vaccine project. He answers key questions on what to know about the ongoing avian influenza (H5N1) developments in �鶹��ý.

Is the bird flu strain in �鶹��ý a risk to humans?

While the virus poses a significant threat to birds, it has limited ability to transmit to humans or mammals, meaning the immediate health risk to people is low. Public health officials emphasize vigilance, but daily life remains largely unaffected.

How did the virus arrive in �鶹��ý, and should the public be concerned?

The virus likely arrived via migratory birds from Asia or the mainland U.S., including Alaska. People are advised to avoid contact with sick or dead birds and report them to the �鶹��ý Department of Agriculture. Those who attended the Mililani pet fair in November should not have symptoms at this point.

What should people do if they come into contact with sick or dead birds, and will bird flu affect life in �鶹��ý long-term?

Anyone who handles sick or dead birds should monitor for flu symptoms and seek medical care if needed. As for long-term effects, the virus is not expected to drastically change daily life for most �鶹��ý residents. While occasional outbreaks may occur, especially among migratory birds, normal precautions should suffice.

What preventive measures should people take, and is the virus mutating?

To reduce risk, avoid contact with sick or dead birds, wash hands thoroughly after any bird interaction, and monitor for symptoms. The virus remains in its wild type form and has not mutated to spread between humans, but scientists are closely monitoring it.

Visit the �鶹��ý Departrment of Health’s for more information.

For the second time, a faculty member from the University of �鶹��ý at Mānoa (JABSOM) has been recognized as an Immunization Champion. Professor Sandra Chang has been honored as �鶹��ý’s 2024 Immunization Champion by the Association of Immunization Managers (AIM) for excellence in promoting immunization efforts in the community.

Funded by the Centers for Disease Control and Prevention, the annual award selects one winner from participating states, territories and the District of Columbia. Chang, chair of the , was selected from a competitive pool of health professionals and community advocates, and received the award during the 2024 �鶹��ý Immunization Update Conference on September 4.

“It has been my honor to serve alongside my colleagues in the �鶹��ý Immunization Coalition to increase vaccine confidence and uptake,” said Chang. “While much work remains to be done, we are all proud of the strides we have made to protect the health of our community.”

Chang joined JABSOM in 1986 as a research scientist specializing in malaria vaccine development. Over the years, she has become a leading voice in vaccine research and public health initiatives. One of her key contributions was co-founding the University Student Immunization Initiative, which focuses on improving vaccination rates among university students.

Dedication to public health

During the COVID-19 pandemic, she played a pivotal role as co-lead of the state’s medical working group for vaccination efforts, ensuring that healthcare providers had accurate information to guide vaccine policy decisions. She also served as co-chair of the vaccination education committee for the Vaccine Preventable Cancer Workgroup and led efforts to create a peer education program in partnership with local high schools to encourage vaccine acceptance.

Chang’s dedication to public health extends to her active involvement with the �鶹��ý Immunization Coalition, where she has helped organize numerous educational initiatives aimed at increasing vaccine confidence across the state.

Lee Buenconsejo-Lum, JABSOM’s associate dean for academic affairs, was honored as an Immunization Champion in 2022.

Editor’s note: The federal government withdrew grant funding for this program in 2025.

Enrollment in the (MHRT) program at the (JABSOM) at the University of �鶹��ý at Mānoa has doubled since global travel restrictions were lifted, growing from six students in 2023 to 12 this past academic year. These 12 students presented their study abroad research at the program’s 11th E Hoʻoulu Haumana on August 15.

Since 2014, this National Institutes of Health-funded program offers undergraduate, post-baccalaureate and graduate students from any discipline opportunities to engage in national or international mentored research projects in fields such as tropical medicine, infectious diseases and community research.

This year, students spent eight to nine weeks conducting research in locations such as Thailand, American Samoa, Guam, and Atlanta, Georgia, directly impacting the communities they served. The MHRT program spans one academic year and concludes with students presenting their research from these out-of-state experiences.

“I am incredibly grateful for the opportunity to participate in the MHRT program,” said Jena Funakoshi, who is concurrently pursuing her master’s and PhD in public health. “It has opened numerous doors for research and networking opportunities. My experience in American Samoa taught me invaluable lessons, allowed me to build relationships that will support me throughout my PhD program, and gave me the chance to learn from a new community and experience a beautiful culture.”

“The students are exposed to hot topics in their area, and sometimes, we’re seeing global concerns, like long COVID and Alzheimer’s dementia,” said Angela Sy, MHRT program director. MHRT also emphasizes the cultural aspects of these regions. “The hope is that this contextualizes life in the places where they’re working,” she added.

Many students advance to grad, med school

MHRT has a strong track record of students advancing to graduate school. About 25% go on to medical school, with many continuing at JABSOM. A large portion of those who don’t pursue medical school go on to earn their master’s or PhD.

Applications for the 12th year of MHRT begin in November. The program is open to students from any major, particularly those h.

“We don’t just look at academics; we seek qualities that will help students succeed in applying for future graduate or professional schools,” Sy said.

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A 2023 Hollywood film Nyad takes viewers on a journey alongside Diana Nyad in her five attempts at a historic 110-mile swim from Cuba to Florida. Annette Bening was nominated for an Academy Award for her portrayal of Nyad in the movie that also starred Jodie Foster. Nyad’s inspiring true story was made possible, in part, by University of �鶹��ý at Mānoa research associate professor Angel Yanagihara.

Yanagihara, who is with the and John A. Burns School of Medicine , played a key role in developing topical technologies (for which she is sole inventor, US Patent #10,172,883) including a cream that prevents box jellyfish stings, a life threatening hurdle Nyad had to face to complete her record breaking swim.

Nyad contacted Yanagihara in March 2012 after she was severely stung by box jellies during her third attempt to complete the swim. She found Yanagihara’s name while searching the internet for people who had anything to do with box jellies.

“I received an email out of the blue with 40 detailed questions,” said Yanagihara. “I looked her up and saw that she had a TED talk and I listened to that and I was immediately smitten by this person and how much discipline she brought to her athleticism and her goal.”

Yanagihara’s own experience with a box jellyfish sting at Kaimana Beach in 1997 that required emergency care. That spurred her research after she discovered no one had studied the venom’s biochemistry. Nyad’s team sought Yanagihara’s expertise and wanted her to accompany Nyad on her next swim attempts.

“They insisted that they absolutely needed me to be on this swim in person,” Yanagihara said. “I realized if I didn’t go, she might very well die because of the lack of general understanding of this venom including the mistaken care that previous folks had given her by injecting her with epinephrine on her last attempt.”

Testing out the cream on herself

At the time, Yanagihara’s research had focused on developing treatments for combat divers and special forces personnel affected by jellyfish stings. However, Nyad sought a preventative solution. Yanagihara conducted various tests on the discharge mechanism of box jellyfish tentacles and found a working combination, which she then compounded into anhydrous lanolin used by long-distance ocean swimmers to prevent chapping.

“After exhaustive in vitro testing, I found a combination that did work,” Yanagihara said. “I went out swimming by myself with it on and then I laid a live box jellyfish on my own skin and it worked!”

Yanagihara’s contribution to Nyad’s swim emphasizes the role of research and collaboration in pushing the boundaries of human achievement.

“It’s very important to highlight that there are highly innovative approaches at the University of �鶹��ý,” said Yanagihara. “This work was initially solely supported by the �鶹��ý Community Foundation. I would like to see novel funding mechanisms at UH to foster a more innovative ecosystem.”

Yanagihara’s character was also cast in the film Nyad and was portrayed by actress Jeena Li.

“While it was fun to be included in name, the Hollywood version of my role was almost unrecognizable. My actual research was not included. I was in the water as a free diver from dusk to dawn, the actress appears to only have been in the water once,” said Yanagihara on being played by Li in the film.

Growing up, Olivia Smith, a recent PhD graduate from the University of �鶹��ý at Mānoa (JABSOM) had always thought her future career would involve medicine. However, while pursuing her bachelor’s degree in neuroscience at the University of Vermont, she realized that she preferred her time at the lab bench and in the field, absorbed in the world of research.

“I thought to myself, ‘oh I really like this.’ I like finding out these intricate pathways and things that make up these evidence-based practices that we can use in the real world,” said Smith, who earned her degree in tropical medicine, medical microbiology and pharmacology at the .

Smith spent two years with the Peace Corps in Peru as a water, sanitation and hygiene educator, pursued a master’s of public health in epidemiology from the University of Massachusetts Lowell, then began her PhD program at JABSOM, just as the COVID-19 pandemic began to take its toll in the U.S.

“The pandemic was quite memorable but I’m really happy with the time I’ve had here. Even though the pandemic definitely hindered it a little—it definitely directed my research and not in a bad way,” said Smith, who successfully defended her dissertation, “Assessing Vaccine Efficacy and Seroprevalence Using Multiplex Immunoassays: Development, Validation, and Applications in Diverse Populations,” in November.

Smith’s research involved three parts, including the development of a tool that detects antibody levels after given a vaccine. This can indicate how effective a vaccine is and how well it works in various groups of people, even those with different health conditions. After analyzing the response to COVID-19 vaccines using these MIAs, she found that comorbidities (diseases or medical conditions that are present simultaneously), such as obesity and diabetes, reduce vaccine efficacy.

Opening the doors for future research

Smith, who was mentored under Associate Professor Axel Lehrer, is hopeful that the results may open the door for future research that perhaps studies specifically-tailored vaccines for those with comorbidities.

“It’s not to say that people with obesity and diabetes shouldn’t get vaccinated, if anything it’s the exact opposite—they should be vaccinated, 100%, because people with these comorbid conditions are more susceptible to severe disease,” Smith said.

With the knowledge gained at JABSOM, Smith is heading back home to Massachusetts with aspirations to do fieldwork in the realm of global public health. Her life experiences and her research have shown her how vaccines can be a great prevention method that can lead to her dream of achieving health equity for all.

“I’m a big advocate for health equity. I think health is a human right. Everyone deserves (good) health,” said Smith.

Read more on the .

An international fellowship recently sent University of �鶹��ý at Mānoa’s Albert To to Africa to research ways to help Liberia determine where insect-borne viruses are present. The (JABSOM) postdoctoral researcher received the 2022 from the American Society of Tropical Medicine and Hygiene. To will conduct research through May in Liberia’s most rural and remote areas.

To’s study will provide a glimpse of the circulating insect-borne viruses in the country, which has scarcely been documented.

His research there will supplement the work started by JABSOM Principal Investigators Vivek R. Nerurkar, chair, and Axel Lehrer, associate professor in the . This is in collaboration with co-principal investigator, Peter Humphrey, at the University of Liberia (UL).

Building on existing research

Nerukar and Lehrerʻs existing project in Liberia looks at the epidemiology of Lassa virus and filoviruses, including Ebola, Marburg and Sudan ebolavirus, which recently swept through Uganda. To’s research will focus on the natural history of West Nile, Dengue, Usutu, Yellow Fever, Zika, Crimean-Congo Hemorrhagic Fever, Rift Valley Fever, O’nyong nyong and Chikungunya viruses.

“The staff at the UL are collecting human and animal samples to check their blood to see if they have any antibodies,” To said. “What the antibodies do is kind of give them a clue about the viruses circulating in that area or have circulated in that area.”

To will conduct a type of surveillance known as “seroepidemiology.” Using blood samples, seroepidemiology is a tool that allows scientists to determine previous exposure to certain viruses.

Study results to aid Liberian health officials

To will inform Liberian health officials of the results, which will allow them to target their outreach about specific viruses more strategically and precisely.

“The Liberians are appreciative of our efforts because there’s not much of this type of research going on,” To said. “There’s few people in Liberia that can do this research. They are actively developing their infrastructure and communication networks, so it’s helpful that we’ll be providing them with important information that they can use to come up with healthcare policies or even containment strategies.”

To’s Liberian trip will be another chapter in UH’s relationship with UL. Students from Liberia have enrolled at the JABSOM, and at the same time, the Department of Tropical Medicine, Medical Microbiology and Pharmacology continues to have a presence in the country on the West African coast.

With only one recipient selected each year, To said he is proud to put JABSOM on the map with this fellowship.

“The previous recipients of this award are from Stanford, MIT and Harvard. JABSOM is a smaller school, and tropical medicine is a small department, so it’s nice to show that we’re up there with those large, well-funded universities.”

An associate professor in the University of �鶹��ý at Mānoa (SOEST) was to the National Academies of Science, Engineering and Medicine’s .

Rosie ʻAnolani Alegado, who is the first Indigenous person appointed to the Ocean Studies Board, hopes to bring consideration for the strengths and challenges in �鶹��ý and the Pacific to this important forum.

“I am honored to serve on a board that has such a tremendous impact on our profession as ocean scientists and more broadly, the United States and the Pacific,” said Alegado. “I intend to introduce new voices, particularly those of Native practitioners, to provide expertise and advice on our marine ecosystems and habitats.”

Alegado is a faculty member with the , the , and Center for Microbial Oceanography: Research and Education is also the director of the and the . She is also co-founder, business and finance director of the John A. Burns School of Medicine’s .

The National Academies of Sciences, Engineering, and Medicine provide expert advice on some of the most pressing challenges facing the nation and world to spark progress for the benefit of society. The Ocean Studies Board explores the science, policies and infrastructure needed to understand, manage, and conserve coastal and marine environments and resources.

“We are excited to welcome Dr. Alegado to the Ocean Studies Board and look forward to her contributions to our work,” said Susan Roberts, director of the Ocean Studies Board.

The board also serves as the U.S. Committee for the , funded by the National Oceanic and Atmospheric Administration, National Science Foundation, Office of Naval Research and the National Academies Presidents’ Funds. The U.S. National Committee for the Ocean Decade will encourage participation and serve as a communication channel for the U.S. ocean science com­munity throughout this international effort.

This appointment is an example of UH Mānoa’s goal of (PDF), one of four goals identified in the (PDF), updated in December 2020.

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�鶹��ý, a prime tourism destination, in combination with its largely multi-racial resident population, presents a unique opportunity to identify and chart the distribution of SARS-CoV-2 variants, the virus that causes the coronavirus disease. The National Institutes of Health has committed $779,792 for two years to the University of �鶹��ý at Mānoa (JABSOM) toward advancing public impact research on the spread and continuing evolution of SARS-CoV-2 variants in the state’s underserved communities.

We want to further understand why certain variants are so much more transmissible than others.
—Vivek R. Nerurkar

The study, “Surveillance of SARS-CoV-2 Variants in �鶹��ý,” is part of the . It is based on the prediction that additional variants will be found in �鶹��ý because of its high influx of recreational travelers from COVID-19 hotspots.

Vivek R. Nerurkar, professor and chair of JABSOM’s , leads a team of graduate students, post-doctoral fellows and bioinformaticians, including the INBRE Bioinformatics Core group, in sequencing and analyzing the genetic information of these variants circulating throughout the state.

“We want to further understand why certain variants are so much more transmissible than others,” said Nerurkar, who has spearheaded COVID-19 diagnostic testing among the underserved and vulnerable populations in the state.

• Related UH News story: New UH lab provides free rapid result COVID-19 testing to underserved, December 4, 2020

The project represents a collaboration with four Clinical Laboratory Improvement Amendments-certified laboratories in Honolulu that perform FDA Emergency Use Authorization COVID-19 diagnostic tests. In addition, the study is providing a unique opportunity for participation by undergraduates in the �鶹��ý INBRE student research program.

Algorithm to predict mutations

The research group’s work preceding this grant was published in , the and in , where they present an algorithm developed to predict particular mutations that can lead to more transmissible COVID-19 variants.

“We developed this model hoping we can contribute to the new generation vaccines so that there is no delay in preparing the new vaccines when variants arrive,” Nerurkar said.

“The work by Dr. Nerurkar and his team will ensure that �鶹��ý is out in front of any new variants of concern either entering the state or arising here on the islands, as part of a national effort to track and quickly respond to the entry and movement of coronavirus variants across the states,” said Principal Investigator and Director of the �鶹��ý INBRE Robert Nichols.

This research is an example of UH Mānoa’s goal of (PDF), one of four goals identified in the (PDF), updated in December 2020.