As 2018 begins, STAT reporters are taking a look at the stories they’re most eager to track this year. Find all our “three to watch” series here

Some years there’s a single global health story that dominates the headlines, like Ebola in 2014 or Zika in 2016. But 2017 wasn’t one of those years.

There were a number of big stories, and big challenges. A devastating cholera outbreak in Yemen. An alarming epidemic of plague in Madagascar. The spread of polio vaccine viruses in Syria, which paralyzed 74 children who were already struggling to survive the country’s relentless and bloody civil war. On a happier note, the World Health Organization got a new director-general, Tedros Adhanom Ghebreyesus of Ethiopia.

What stories will we tell about 2018? The crystal ball is cloudy, but the haze parted long enough for STAT to discern a few things. Here are three predictions.

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Polio will face a full-court press

2018 marks the 30th anniversary of the launch of the effort to annihilate polioviruses. The original — and ambitious — goal was to eradicate polio in time to celebrate the start of the new millennium.

The world missed that goal, and several other target dates after that one. We’ve heard so many people predict so often that “This is the year…” (ahem, Mr. Bill Gates) that we take those kinds of forecasts with a sack of salt. Polio, after all, has proven itself to be the wiliest of foes.

That said, there were fewer cases in 2017 than any year in history. As the year ended, there had been 20 confirmed cases — 12 in Afghanistan and eight in Pakistan. It can take up to four weeks for cases to be reported and lab-confirmed, so the year-end total could still inch a bit higher, acknowledged Michel Zaffran, WHO’s director of polio eradication. Still, the tally will be lower than the 2016 count, when 37 cases were recorded in Afghanistan, Pakistan, and Nigeria.

“The virus is fighting for its survival, but the countries and their partners are determined to see its end in the coming months,” Zaffran told STAT. “Countries and [polio campaign] partners are investing a lot of time, human and financial resources, and efforts to interrupt transmission in the coming low transmission season,” which begins now and ends approximately at end of May.

Conflict zones — where vaccinating children is dangerous, difficult business — have given polio safe havens. And rooting the viruses out of their last reservoir won’t be easy.

But don’t count out the good guys, who in 2017 recruited a formidable foe of their own: professional wrestler, actor, and all-around awesome guy John Cena. And you know what John Cena says: “Never give up.”

Geneva, we’ve got a problem

Tedros, as he is known, inherited a challenging job when he was selected to replace former director-general Margaret Chan by the WHO’s member countries last May. But he won the six-person race decisively, which suggested he had widespread support in the capitals of the world.

How solid that support remains is unclear. After a strong start, Tedros stumbled badly in October when he appointed since-deposed Zimbabwean president Robert Mugabe as a WHO goodwill ambassador for noncommunicable diseases. The announcement was met with derision and dismay, and the proffered appointment was speedily withdrawn.

The incident shook confidence in the new DG. And that’s a currency Tedros cannot afford to lose.

The WHO is facing a looming budget crunch — crush might be a better word. The polio eradication program brings in $1 of every $4 in funding WHO gets; other programs piggyback off that money. When the polio program is done, there are no guarantees that money will continue to come in for different projects.

Tedros has launched an internal reform program, and he and the agency’s executive board — 34 countries that serve for three-year terms — are in the process of hammering out the roadmap for his tenure, called the General Program of Work.

At the inaugural meeting in November, Tedros outlined what he calls the “triple billion target.” By promoting access to health care and focusing on WHO’s health emergencies response capacity and health priorities, 1 billion more people should have health coverage, 1 billion more would be safer from health threats, and 1 billion lives would be improved.

The responses were conflicting. Tedros was urged both to focus the WHO’s efforts more narrowly on what the agency is uniquely positioned to do — and asked why a shopping list of other priorities raised by member countries were not included. He was instructed to come up with a new draft, due by this Friday, and to provide details about how the triple billion target’s estimates were calculated.

Tedros and the agency he leads have some challenging times ahead.

Speaking of anniversaries …

Get ready for a lot of talk about how vulnerable the world is to massive disruption because of disease outbreaks.

This year marks the centenary of the Spanish Flu, the influenza pandemic of 1918, which killed somewhere between 50 million and 100 million people as the H1N1 flu virus swept the globe.

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Many of the people who died were in the prime of life. There are unsettling reports of people who were well at breakfast and dead by dinner. This uniquely fatal outbreak haunts influenza scientists and emergency response planners to this day.

The latter know health systems don’t have the capacity to cope with the huge upsurges in illness that would accompany a major disease outbreak. A regular old bad flu season can severely tax hospitals.

Those who worry about these issues will use the anniversary to focus attention on the risk of “the next Big One.”

Some will warn we’re overdue for a big disease event, but the truth is nature isn’t on that type of a schedule. Still, at some point, there will be another SARS-like event, another Ebola crisis. And at some point there will be another flu pandemic.

Will that be in 2018? Sadly, our crystal ball has clouded over again.

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