Since its inception, the Florida Birth Defects Registry—powered by a 25-year partnership between USF and the Florida Department of Health—has been at the forefront of Florida’s response to emerging public health threats. From monitoring congenital Zika syndrome during the 2016 Zika virus outbreak, to shaping national case definitions for neonatal abstinence syndrome amid the opioid crisis, to strengthening electronic health record access and data interoperability during the COVID-19 pandemic, to contributing to early investigations of oropouche virus-related outcomes in Florida, our interagency team has consistently transformed surveillance into action that protects Florida’s mothers, infants, and families.