Researchers Alika Maunakea and Ruben Juarez are leading the Maui Wildfire Exposure Study (MauiWES), one of the largest postfire health investigations in the country, following survivors of the August 2023 fires that devastated Lāhainā and surrounding areas. The study emerged from efforts to understand how wildfire exposure affects long-term health, particularly from fires combining brush, forest, and urban elements that create complex toxic mixtures. The research has expanded beyond its original scope to become a critical health resource for Maui’s underserved rural communities, which face significant physician and nursing shortages and limited access to specialty care.
Participants provide blood, urine, saliva, DNA samples, and undergo health assessments including lung function and mental health evaluations. Approximately 2,000 individuals have enrolled, and preliminary results released in 2024 and 2025 indicate declining lung health and mental health outcomes among the cohort. Testing also revealed continued heavy metal exposure among residents. Beyond research data, the study has provided participants with primary care screenings, health navigation, and mental health counseling. According to data from the study, 60% of participants reported it as their first health check since the fire, more than 800 followed up with healthcare providers afterward, and approximately 300 accessed mental health services through the program.
Maunakea and Juarez are developing a planned nonprofit called HO’ALA (Health Outreach ‘Āina-based Life-course Alliance) to institutionalize and expand the health services and research infrastructure created by MauiWES. The organization would function as a hybrid community health center and research facility focused on environmental health impacts in rural areas, particularly following climate-related disasters. However, the study faces significant funding challenges and administrative obstacles. State funding ended, though Maui County provided support in July to sustain operations through the end of the year, and recent NIH approval should provide approximately one-quarter of annual costs for the next three years.
The study has encountered criticism from Hawaii’s Department of Health leadership, with director Kenneth Fink disputing findings about elevated heavy metals and requesting oversight of future publications. University officials and external experts have defended the researchers’ methodology and results as high-quality work. Multiple specialists noted that early state testing using lead as an indicator of toxic exposure was insufficient, as different chemicals behave differently in the environment and body, with substances like dioxins remaining in the system for seven to 11 years. Experts have characterized MauiWES as an innovative model for rural health and disaster recovery that could serve communities nationwide as wildfire threats increase across the Western states and beyond.
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