I traveled more than 9,000 miles from Las Vegas to Zanzibar this summer to study how climate change exposes weaknesses in health systems. I expected to come home thinking about islands, flooding and access to care. Instead, I came home thinking about a preventable disease in my own community.

In Clark County, babies are still being born with congenital syphilis.

Congenital syphilis occurs when syphilis passes from a pregnant patient to a fetus. It can cause miscarriage, stillbirth, neonatal death, blindness, deafness, developmental delay and skeletal abnormalities. Yet timely testing and appropriate treatment during pregnancy can prevent it. That is what makes Clark County’s numbers so difficult to accept.

A 2025 CDC analysis examined 195 Clark County mothers who delivered an infant with congenital syphilis between 2017 and 2022. Only 43.1% reported receiving prenatal care. But 57.4% had at least one emergency-department encounter 30 or more days before delivery that represented a possible opportunity for syphilis testing. Testing was not performed at nearly one-third of those encounters.

Those numbers should change how we think about the emergency department. For patients who reliably receive prenatal care, the ED is a safety net. For others—including people experiencing homelessness, poverty, unstable insurance, transportation barriers or immigration-related fear—it may be one of the few places where the healthcare system gets a chance to find them.

I work in emergency-medicine research at University Medical Center in Las Vegas, where my current public-health research examines syphilis testing and treatment among pregnant ED patients. The lesson is deceptively simple: healthcare is not accessible because a prenatal clinic exists somewhere in the city. Access exists when the patient can actually reach care, receive the right test at the right time, obtain treatment and remain connected to the system.

Academic public health has a role here, too. Schools and programs can help translate surveillance data into workflows that prevent harm, evaluate whether new laws are actually reaching patients, and partner with health systems and local agencies to identify who is still being missed. Policy matters, but implementation determines whether policy becomes prevention.

That is also a human-rights issue. Article 25 of the Universal Declaration of Human Rights recognizes a right to medical care and specifically states that motherhood and childhood are entitled to special care and assistance. A preventable infection becomes a rights failure when our system repeatedly encounters pregnant patients yet fails to connect testing with treatment.

Nevada has taken an important step. Assembly Bill 360, effective January 1, 2026, strengthened syphilis screening requirements for pregnant patients in emergency departments, labor and delivery units and nonhospital medical facilities. It requires testing in specified circumstances and directs facilities with a positive result to seek consent to begin treatment or refer the patient for treatment. But passing a testing law cannot be the finish line.

This matters in migrant health because prevention cannot depend on a patient’s immigration status, English proficiency, insurance card or familiarity with the American prenatal-care system. Nevada hospitals, urgent-care operators, the Department of Health and Human Services and local health districts all have a role in making the new law work for the patients most likely to fall through traditional care.

Nevada should build a statewide Test. Treat. Connect. standard.

First, syphilis screening should function as routine opt-out care whenever an eligible pregnant patient presents to an emergency department or urgent-care setting. It should not depend on why she came through the door or whether an overextended clinician remembers to add one more order. Electronic health records can automate eligibility prompts and document a patient’s decision to decline.

Second, a positive test should trigger treatment during the same encounter whenever clinically appropriate and feasible. The Clark County CDC analysis found that among mothers without prenatal care who were tested more than 45 days before delivery, none received timely treatment. Finding disease without creating a reliable path to treatment is surveillance, not prevention.

Third, we need a warm handoff, not a phone number on discharge paperwork. Southern Nevada already has infrastructure to do this. The Southern Nevada Health District’s Congenital Syphilis Case Management Program provides nurse and community-health-worker case management, treatment support and connections to prenatal care, insurance, housing, transportation and food resources. Hospitals and urgent-care systems should create automatic referral pathways into that program for pregnant patients with positive tests and no established prenatal care.

Nevada should then publicly measure the entire prevention cascade: patients eligible for screening, patients tested, positive results, treatment completed, prenatal-care linkage and congenital syphilis outcomes. Accountability should follow the patient beyond the laboratory result.

Zanzibar taught me that health systems fail in the spaces between services: between a village and a hospital, between diagnosis and treatment, between what technically exists and what a patient can actually reach. Las Vegas is not Zanzibar. But that lesson followed me home.

Nevada has already decided that pregnant patients should be tested. Now we need to make sure a positive test leads somewhere.

Test. Treat. Connect. The outcome that matters is not how many tests we order. It is how many babies never develop a disease we already know how to prevent.