Advancing diagnosis is advancing health. CSR REPORT 2022 2023
2 CONTENTS Unless otherwise specified, the published figures are those for 2022 © 2023 Photographs: ©Adobe Stock / P. 3, 5, 17, 22, 23, 31, 35, 41, 51 ©Cerba HealthCare / P. 21 ©Cerballiance / p. 29 ©Cerba HealthCare Italia / p.32 ©Getty Images / P.37 ©Cerba Lancet Africa RSmedia. Graphic design: Élodie Cavel 1 THE GROUP AND ITS CSR STRATEGY.............5 Presentation of the Cerba HealthCare Group..........6 Our stakeholders........................................................12 Our CSR strategy........................................................13 Our contribution to the Sustainable Development Goals...................................................15 2 CONTRIBUTE TO THE HEALTH OF ALL..........17 Address major public health issues.......................18 Improve access to our products and services.....21 Towards a One Health approach............................25 Maintain high quality of diagnosis..........................26 Develop solidarity.......................................................28 3 DEVELOP HUMAN CAPITAL...........................31 Develop skills and employability.............................33 Promote health and quality of life at work............36 Develop male-female parity and equal opportunities............................................38 4 REDUCE THE ENVIRONMENTAL IMPACT OF OUR OPERATIONS.....................................41 Ensure climate conservation...................................42 Site energy use...........................................................45 Reduce the impact of our transport.......................46 Reduce our consumption.........................................47 Waste management..................................................48 Reduce water consumption and pollution............49 5 PROMOTE EXEMPLARY BUSINESS ETHICS..51 Protect the personal data of patients and collaborators.......................................................52 Prevent the risks of corruption................................54 Prevent risks posed by third parties.......................55
EDITORIAL Advancing diagnosis is advancing health. At Cerba HealthCare, this profound conviction leads us to explore the infinitely small, rallying our combined expertise to favour the emergence of a diagnosis, contribute to treatment efficacy and promote prevention: clinical pathology, imaging, clinical trial pathology, anatomical pathology, genetics... We channel all our skills into meeting the needs of the medical communities and populations and into evolving our policies towards increased prevention. As a healthcare player, the Cerba HealthCare mission has historically been one of common good. A commitment that has progressively grown to encompass the various facets of corporate social responsibility (CSR). Because whatever the form, committing to a sustainable planet is now everyone’s responsibility. For Cerba HealthCare, this commitment comes with two profound convictions: it must maintain a strong link with our business and its values, and it must take the form of specific actions. Within the Group, many emblematic initiatives of this approach were born well before we imagined that they would find a legitimate place in a CSR report, be it our historical investment in the professional development of our collaborators, the medical community or the creation of Institut Cerba to improve access to care for the most disadvantaged. Finally – and without doubt it is the foundation we all share – the values of the Group occupy a cardinal place in this process. Beyond the element of cohesion that is vital to the company's development, they represent the foundation of our CSR approach: Excellence, Commitment, Boldness and Respect guide the behaviours of each and every one of us, enabling us to create a CSR roadmap that is all the more sustainable because it is true to what we are. Fortified by this ambition, we have defined a CSR strategy that goes beyond what one might legitimately expect from a healthcare player, particularly on the question of ethics, to include environmental and social themes. We also found it essential to maintain this ambition at all Group levels, which is why the CSR roadmap will be driven and facilitated by all of our collaborators. Because beyond measures, pillars, perimeters and other indicators, what no report will ever tell us is the collective strength. What no report can really assess is the need to infuse work with meaning. And that is where our ultimate ambition lies. Sincerely, Jérôme Thill CEO Cerba HealthCare 3
5 1. THE GROUP AND ITS CSR STRATEGY ‘For a Group whose purpose is of clear societal interest, the integration of CSR issues into its strategy and business lines is natural. The role of the CSR Department is to guide and support the company in an ever more ambitious trajectory.' Valéria Maio, Group CSR Director
PRESENTATION OF THE CERBA HEALTHCARE GROUP Cerba HealthCare's mission is to support the evolution of a curative health system towards a more preventive system. It draws on more than 50 years of expertise in clinical pathology to reveal the full potential of diagnosis. 6 THE GROUP AND ITS CSR STRATEGY
Our Group in figures 130 technical platforms 1,265 laboratories 2,500+ types of tests 320,000+ tests performed every day 2.5 billion euros in turnover 1,000 scientific publications to date 85 million patients 15,640 collaborators 89 nationalities 7 Veterinary clinical pathology Medical imaging Anatomo-cytopathology Preventive testing Clinical pathology for clinical trials Specialised clinical pathology Routine clinical pathology Specialised and routine clinical pathology Biologie vétérinaire Imagerie médicale Anatomocytopathologie Biologie préventive Biologie d’essais cliniques Biologie de spécialités Biologie de proximité Spécialités & proximité re e hologie ve Biologie d’essais cliniques Biologie de spécialités Biologie de proximité Spécialités & proximité re hologie Biologie d’essais cliniques Biologie de spécialités Biologie de proximité Spécialités & proximité
A STRATEGY FOR BUSINESS DIVERSIFICATION AND GEOGRAPHIC EXPANSION . Laboratoire Cerba, at the origin of the Cerba HealthCare Group, was established in 1967. Performing clinical pathology services on behalf of other public and private laboratories across the globe, it has rapidly become a global reference in specialised clinical pathology. The year 2007 marks the beginning of the diversification of the Group's activities and geographical position. 1967 – 2007 Actor in specialised clinical pathology and anatomocytopathology 1967: Creation of Laboratoire Cerba 1998: Merger with the Centre de Biologie Médicale Spécialisée [Specialised Clinical Pathology Centre] of Institut Pasteur, an expert in infectious diseases 1998: COFRAC accreditation according to the standard ISO/ IEC 17025: Cerba becomes the first private accredited laboratory in France 2000: Cerba creates the first clinical pathology training organisation for healthcare professionals 2015: Creation of the Institut Cerba endowment fund 2016: Launch of Cerba HealthCare University 2016: Cerba is the first private laboratory to perform whole exome sequencing and become active in the diagnosis of rare constitutional genetic diseases 2012: Laboratoire Cerba becomes the first private French laboratory to obtain a high-throughput sequencer and to offer, as of 2013, the NIPD test, a non-invasive prenatal diagnostic for trisomies 13, 18 and 21 on foetal DNA 2013: Launch of Biopredix, the first range of preventive medicine check-ups to preserve health capital 2020: Creation of Cerba Path, an entity that brings together anatomical pathology and cytology activities in France 2021: Acquisition of LifeBrain in Italy and Labexa in France Acquisition of ViroclinicsDDL, a specialist in clinical trials in virology and immunology 2022: Creation of the Group's CSR Department and publication of its first CSR report 2007 Geographic and business diversification: Routine clinical pathology and clinical pathology for clinical trials in Belgium 2009 – 2014 Geographic and business diversification: Routine clinical pathology in France and in Luxembourg 2015 – 2016 Business diversification: Veterinary clinical pathology 2017 – 2019 Geographic and business diversification: Routine clinical pathology in Italy and Africa and medical imaging in Italy 2020 – 2021 COVID-19: Key player in screening and epidemiology Consolidation of market positioning in routine clinical pathology in France 2018: Creation of the Cerba Vet College, a training organisation for veterinarians 2019: Launch of Innov Lab, the Group's ideas platform 8 THE GROUP AND ITS CSR STRATEGY
ENTITIES DESCRIPTION SPECIALISED CLINICAL PATHOLOGY Laboratoire Cerba Reference laboratory performing specialised tests, working on behalf of private and public medical pathology laboratories, healthcare establishments, healthcare professionals and public institutions, in more than 50 countries 4,000 tests per day 660 collaborators LOCAL CLINICAL PATHOLOGY SERVICES Routine clinical pathology takes the form of sampling activities through a network of laboratories that receive patients, and technical platforms that analyse these samples. Cerballiance Network for Metropolitan France and Réunion 700 local laboratories 40 technical platforms 7,800 collaborators CRI, LBS, Ketterthill Network for Belgium and Luxembourg 57 laboratories 4technical platforms 500 collaborators Cerba HealthCare Italia Network for Italy 360 laboratories 26 technical platforms 3,100 collaborators Cerba Lancet Africa Network in 14 African countries 170 laboratories 5technical platforms 1,800 collaborators CLINICAL PATHOLOGY FOR CLINICAL TRIALS Cerba Research Present on 5 continents, Cerba Research provides the pharmaceutical industry with expertise in clinical pathology for clinical trials and diagnostics by managing patient recruitment, analysis, transport and storage of samples. 10 technical platforms 1,100 collaborators VETERINARY CLINICAL PATHOLOGY Cerba Vet and Antagène France Covering all veterinary pathology specialities, anatomical pathology and genetic tests, on behalf of veterinary clinics 2technical platforms 60 collaborators MEDICAL IMAGING Cerba HealthCare Italia In addition to clinical and clinical pathology tests, Cerba HealthCare Italia provides medical imaging, used to diagnose many diseases. 7radiology centres ANATOMICAL PATHOLOGY AND CYTOLOGY Cerba Path Develops and performs the most innovative personalised medical tests every day and evaluates the therapeutic success of the treatments recommended for patients with cancer. 5technical platforms (France and Belgium) 1technical platform in Côte d’Ivoire 250 collaborators 9 KEY DIAGNOSTIC EXPERTISE THROUGHOUT THE MEDICAL JOURNEY
10 OUR BUSINESS MODEL SERVING OUR MISSION: Advance diagnosis to advance health OURRESOURCES HUMAN RESOURCES 15,640 collaborators from 89 nationalities, including 74% women TERRITORIAL ANCHORAGE 1,265 routine clinical pathology laboratories worldwide INNOVATION Incubation of start-ups and public/private partnerships ANCHORAGE IN SCIENTIFIC COMMUNITIES Regular partnerships with universities SHARE OWNERSHIP 650+ shareholder collaborators (managers and pathologists) NATURAL CAPITAL 57,336 MWh of energy consumed 6 areas of diagnostic expertise covering the entire value chain… SPECIALISED CLINICAL PATHOLOGY ROUTINE CLINICAL PATHOLOGY CENTRAL LAB TESTING FOR CLINICAL TRIALS AND DIAGNOSTICS VETERINARY CLINICAL PATHOLOGY MEDICAL IMAGING ANATOMICAL PATHOLOGY AND CYTOLOGY
• Oncology • Haematology • Gynaecology • Immunology • Virology • Urology • Fertility • Dermatology • Pulmonology • ENT... 11 OURIMPACTS FINANCIAL RESULTS 2.5 billion euros in turnover HEALTH IMPACT Catalogue of 2,500+ tests 85 million patients Key player in screening campaigns for colorectal cancer and sexually transmitted infections HUMAN IMPACT 50% of collaborators trained, voluntary turnover of 12.8%, 97% of French collaborators covered by a profit-sharing agreement SOLIDARITY Some twenty projects supported by Institut Cerba ENVIRONMENTAL IMPACTS 1003 Kt CO2 eq greenhouse gas emissions This expertise involves a large number of techniques and know-how... ...and meets the needs of patients and the medical community. To fulfil its mission, the company incorporates the necessary technologies to: 1. Contribute to more predictive medicine, target and adapt therapies for better patient care. 2. Support the pharmaceutical industry, CROs (Contract Research Organisations) and biotechnology companies in the development of their medicines. • Cytogenetics • Molecular genetics • Biochemistry • Microbiology • Imaging • Fluid and tissue analysis
OUR STAKEHOLDERS Dialogue with our stakeholders enables us to understand their expectations, remain attentive to changes in society, and adapt our practices. 12 THE GROUP AND ITS CSR STRATEGY PATIENTS INVESTORS AND FINANCIAL PARTNERS AND SUPPLIERS SUBCONTRACTORS PRESCRIBERS PROFESSIONALS, HEALTHCARE ORGANISATIONS AND TRAINING INNOVATION RESEARCH, CIVIL SOCIETY NGOs AND GOVERNMENT INSTITUTIONS AND AUTHORITIES EMPLOYEES Satisfaction surveys, Digital applications, Website and social media. Quarterly meetings of the Board of Directors, Investors’ website, annual and half-yearly financial reports, press releases, etc. Internal communication, Induction programme, Training, annual appraisals, Hotline, whistleblowing system, Workforce dialogue. Communication with regulators and decision-makers on critical issues affecting the clinical pathology sector. Associations supported by the Group and Institut Cerba, Thematic conferences. Partnerships and research projects, Scientific studies, Participation in symposia, seminars. Communication on panels of tests and services, Congresses, specialised trade shows, scientific conferences. Code of Business Conduct Whistleblowing system CERBA HEALTHCARE
OUR CSR STRATEGY In 2022, the Group defined a CSR strategy aimed at setting objectives for its most important issues and a governance structure to manage it. This CSR strategy is based on the materiality analysis conducted in 2021. THE MAIN CSR ISSUES FOR THE GROUP The Group conducted a materiality analysis to identify and classify its CSR issues according to their importance for its business and stakeholders. The material issues were grouped into 4 themes that define our CSR pillars: Health, Human capital, Environment and Business ethics. Unsurprisingly, the issues of health and protection of personal data appear to be the most strategic for the Group. The materiality analysis also highlighted the rise in issues related to the environment and human capital. Finally, the issues related to human rights violation and risks of corruption are addressed with the utmost rigour despite the moderate exposure for Cerba HealthCare. 13 Diversity Corruption Human rights Governance Protection of personal data Waste and pollution Supply chain and third parties Climate change Accessibility Quality Sustainable products and services Health/safety and quality of life Training and employability MODERATE HIGH VERY HIGH LOW LOW VERY HIGH VERY HIGH RELEVANCE TO THE BUSINESS IMPORTANCE TO THE STAKEHOLDERS ENVIRONMENT CSR ISSUES HUMAN CAPITAL HEALTH BUSINESS ETHICS
CSR INTEGRATED AT ALL LEVELS OF THE COMPANY To support this strategy, the Group has created a form of governance aimed at integrating the subject at all company levels, be it the Board, the Group Management Committee, countries, territories or business lines. CSR INTEGRATED INTO THE REMUNERATION OF TOP MANAGEMENT Since 2022, the variable part of the Management Committee members’ annual remuneration contains a CSR objective in line with their scope of action. These committees are based on networks historically in place: human resources, legal, pathologists, quality. 2023: establishment of a green network for each subsidiary, coordinated by a CSR contact Group Environment Committee Board-level CSR Working Group Senior Management CSR Department Group Human Capital Committee Group Health Committee Group Business Ethics Committee General Secretariat participates 14 THE GROUP AND ITS CSR STRATEGY TO THE HEALTH DEVELOP THE ENVIRONMENTAL EXEMPLARY CONTRIBUTE REDUCE PROMOTE OF ALL HUMAN CAPITAL IMPACT OF BUSINESS ETHICS OUR OPERATIONS CSR GOVERNANCE Public health Accessibility One Health approach Quality Solidarity Personal data Corruption risks Partners and suppliers Skills Equality and diversity Quality of life at work Carbon impact Waste Water THE CERBA HEALTHCARE CSR STRATEGY . The Cerba HealthCare CSR strategy is based on 4 main pillars, with which are associated governance, roadmaps and objectives, at Group and entity level. It aims to maximise the positive impacts linked to our activities and our mission, and to improve the Group's social and environmental impact. facilitates
CSR PILLARS SDG OUR ASSOCIATED OBJECTIVES HEALTH Objective 3 Ensure healthy lives and promote well-being for all at all ages Reinforce our role in prevention HUMAN CAPITAL Objective 5 Achieve gender equality and empower all women and girls 45% women in the governing bodies in 2028 ENVIRONMENT Objective 12 Ensure sustainable consumption and production patterns Reduce the production of waste and improve its recycling A carbon emission trajectory aligned with the Paris Climate Agreement (SBTi methodology) Objective 13 Take urgent action to combat climate change and its impacts BUSINESS ETHICS Objective 8 Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all Prevent the risks of corruption and the social and environmental risks posed by third parties. 15 OUR CONTRIBUTION TO THE SUSTAINABLE DEVELOPMENT GOALS Through its model, strategy and actions, Cerba HealthCare contributes to the Sustainable Development Goals (SDGs) adopted by the Member States of the United Nations in 2015, in order to address the ecological, social and economic challenges that face the world.
CONTRIBUTE TO THE HEALTH OF ALL
17 2. CONTRIBUTE TO THE HEALTH OF ALL ‘Our mission and our different areas of expertise converge towards highquality diagnostic care. This must contribute to placing the patient at the centre of the care pathway and help them become an informed player in their own health.’ Stéphanie Haim Boukobza, Medical Director of the Cerballiance network
18 CONTRIBUTE TO THE HEALTH OF ALL ADDRESS MAJOR PUBLIC HEALTH ISSUES Cerba HealthCare is developing new tests and participates in many research projects, with the aim of improving patient care. FIGHT CANCER Despite the major advances of recent years in healthcare and research, cancer affects around 335,000 new people each year in France and causes 150,000 deaths1. Cerba HealthCare participates in fighting cancer thanks to its expertise in anatomical pathology, and to its development of new tests and innovative and strategic research programmes. The Laboratoire Cerba Oncology business is developing rapidly in order to meet the challenges of prevention in oncology and the improvement of treatments. Precision medicine is used to personalise treatment, which is adapted to the patient's disease and targeted to maximise its efficacy. Progress that is notably achieved thanks to liquid biopsy which alongside solid biopsy helps to improve the diagnosis of cancers. In early 2023, Laboratoire Cerba launched Cerba Oncology, a platform to facilitate access to a wide range of innovative and customisable oncology analyses and accelerate diagnosis through a connected prescription solution2 and medical support from the choice of test to the interpretation of the results. In 2021, Cerba Research formed a strategic partnership with ACT Genomics to create a centre of excellence in immuno-oncology in Taipei, called CerbACT Asia. Bringing together the cutting-edge technologies in this field, this centre enables improved patient results in all clinical trial phases. 1. Figures from the Cancer page of the French Ministry of Health and Prevention (2023) website: https ://sante.gouv.fr/ soins-et-maladies/maladies/article/cancer 2. More information on the Cerba Oncology platform website: https ://oncology.mycerba.com/fr All united against cancer • Distribution of 2,000 bracelets to support the Caregiver association. • Support of 2 associations led by collaborators: Association pour la Recherche sur les Tumeurs Cérébrales (ARTC) and NOI DONNE Soprattutto. • Organisation of an internal walking challenge to support the Hope association and the Movember foundation.
19 BETTER DIAGNOSE AND TREAT MENTAL HEALTH DISORDERS According to the World Health Organization (WHO), 1 in 4 people are affected by mental health disorders at some point in their life. Demand for care is constantly increasing, especially for anxiety and depressive disorders, psychological trauma, behavioural disorders and addictions. In 2022, Laboratoire Cerba and Taliaz joined forces to offer physicians a new clinical test to predict the efficacy of antidepressant treatments: PREDICTIX, developed by Taliaz, uses a biological test combined with artificial intelligence to guide the care of patients with depression and orient towards the drug with the greatest chance of giving the best therapeutic outcomes from the first treatment. The solution will be available to patients in the second quarter of 2023 through the Cerba HealthCare Group routine clinical pathology network, in France and abroad. The COVID-19 epidemic highlighted the major role of the community laboratory networks in monitoring an emerging epidemic The first case of Monkeypox virus in France was diagnosed by the pathologists of Cerballiance Paris Île-de-France. Our network identified 75% of the cases diagnosed in Île-de-France and worked in conjunction with the health authorities and hospital networks to provide the best support to the patients concerned. Thanks to the samples taken by the Cerballiance teams and the tests conducted at Laboratoire Cerba, the Cerba HealthCare Group was able to offer comprehensive and appropriate outpatient care, enabling the patients to avoid a visit to the Accident and Emergency Department. Thus the role of the pathologist, which is essential in mass screening campaigns, is also important for the epidemiological monitoring of viruses by: • obtaining information on a medical/ health situation through reliable scientific data, • demonstrating its development, • informing the authorities which will decide on the measures needed to protect the population.
20 CONTRIBUTE TO THE HEALTH OF ALL FACILITATE ACCESS TO THE DIAGNOSIS OF RARE DISEASES Over 3 million people in France and around 25 million in Europe are affected by one of the 7,000 rare diseases known to date. Only 1 in 2 people with a rare disease has an accurate diagnosis, which is essential for implementing genetic counselling or appropriate treatment and thereby improving patient care. Laboratoire Cerba fights delayed diagnosis through a multidisciplinary approach (specialised biochemistry, genetics, constitutional cytogenetics, genomics, flow cytometry, etc.) and the development of new tests. In order to improve the accuracy of genetic disease diagnosis, the human genetics teams have established a new test at Laboratoire Cerba: a next-generation cytogenetic diagnostic test more commonly known as optical genome mapping. This new technology improves the diagnosis of rare constitutional genetic diseases and complements whole exome sequencing, which has been performed at Cerba since 2016. Furthermore, the teams have since 2021 expanded the use of gene panels in high-throughput sequencing for syndromic approaches, thereby significantly advancing the molecular diagnosis of many human genetic diseases (intellectual deficiency, epilepsy, etc.). Identifying causative variants means that a clinical diagnosis can be made, a genetics consultation can be offered, and sometimes care can be improved by proposing personalised treatment. Following the validation study of the non-invasive diagnostic test for De Vivo disease, conducted in 2021 by Cerba in partnership with METAFORA biosystems and AP-HP, over thirty patients per month have benefited from this new test. Within 48 hours this blood test identifies affected children and adults quickly and easily compared with the diagnostic tests that use an invasive procedure (lumbar puncture) or complex genetic analyses. De Vivo disease, otherwise known as Glut1 deficiency syndrome, is a rare and debilitating neurological disease that is relatively unknown to the medical profession, yet totally manageable with diet if detected early. TOWARDS MORE PUBLIC-PRIVATE PARTNERSHIPS The Cerba HealthCare Group, thanks to the diversity of its expertise and know-how in specialised clinical pathology, is a contact and partner of choice for conducting various research projects and partnerships. In 2022, Cerba HealthCare was a stakeholder in COVIFERON, a project co-conducted with the Imagine Institute and other academic partners, and selected for the fifth call for hospital-university health research proposals (RHU 5) launched in 2021 by the French National Research Agency (ANR) as part of the Investments for the Future Programme (PIA). It aims to better understand the genetic and immunological foundations of the different clinical forms of COVID-19, develop and distribute tests to evaluate the risks of developing a severe form, and propose new preventive and therapeutic approaches – particularly in the context of infectious or autoimmune diseases. Cerba HealthCare participates as a financial partner and via the Cerballiance network has the role of validating and implementing the tests. In 2023, Cerba HealthCare is a stakeholder in three candidate projects for the sixth wave of the RHU.
21 IMPROVE ACCESS TO OUR PRODUCTS AND SERVICES To improve access to healthcare for everyone, we welcome all patient profiles in the best conditions. SERVICES TO SUIT SPECIFIC NEEDS We endeavour to provide all our patients with the best experience and to receive them under the best conditions. • Cerba Kids: Our medical teams have set up this service in 181 Cerballiance3 laboratories, offering a space dedicated to children and an application enabling them to understand the process of taking a blood sample and its utility. The aim is to reassure children and improve their experience like that of their parents. • Cerba Mam: Pregnancy monitoring forms an integral part of the missions of the local laboratory pathologist. As part of an appointment with the expectant mother early on in her pregnancy, the pathologist takes the time to explain the various tests that will be prescribed during the pregnancy and their utility. This is an opportunity for the pathologist to also provide advice on diet and hygiene precautions. In addition, patients can access personalised content on the Cerballiance4 website, with information and advice on the various tests, thanks to a dedicated health blog. In Luxembourg, Ketterthill launched in 2021 a pregnancy monitoring service for women who are pregnant or planning a pregnancy, offering full support for pregnant women, educational explanations on prescribed tests, health and nutrition advice, and a comprehensive pregnancy booklet to download from their website5. 3. Number of Cerballiance laboratories offering the Cerba Kids service at the end of 2022 4. Link to the Cerballiance Pregnancy health blog: https ://www.cerballiance.fr/fr/blog/grossesse 5. Link to the Ketterthill pregnancy booklet: https ://www.ketterthill.lu/fr/nos-services/suivi-de-grossesse.htm Cerba Lancet Africa: deployment of our strategy for greater access to care Cerba Lancet Africa's 1,800 collaborators support the evolution of the diagnostic offer towards better access and quality for the African population which is the fastest growing in the world. Therefore, access to care and the quality of the diagnostic offer are at the heart of our model in Sub-Saharan Africa. This strategy is based on three main areas: • Develop an optimal territorial network in terms of the economic, logistical and operational characteristics of each region; • Adapt our pricing solution for patients who do not benefit from a comprehensive social security system; • Propose a comprehensive diagnostic offer that meets the needs of the patient by developing an integrated offer of diagnostic centres (laboratories, medical imaging, general medicine).
22 CONTRIBUTE TO THE HEALTH OF ALL GET CLOSER TO OUR PATIENTS THROUGH INNOVATIVE SERVICES The Group is implementing several off-site clinical pathology projects in France and Nigeria. Also referred to as Point of Care Tests (POCTs), their objective is to make quality diagnoses within a few minutes beyond the walls of the laboratory. For example, Cerballiance Charente forms part of an initiative trialling a care pathway that incorporates off-site pathology for chronic patients on vitamin K antagonists (VKA), and has deployed POCTs at two dialysis centres in La Rochelle and Île d'Oléron. For these patients, the rapidity of the results improves their care thanks to better coordination between healthcare professionals along with the follow-up and, if necessary, rapid adjustment of their treatment. In Nigeria, such an approach enables access to rapid and high-quality diagnosis in areas that are less accessible or less well-equipped. In order to reach as many patients as possible and address the difficulties of accessing healthcare, we also promote patient care at home when this is necessary (difficulty in travelling, frail patients undergoing chemotherapy or hospitalised at home, rural areas, etc.). We take samples ourselves from patients at their homes or organise test collection rounds in rural areas in partnership with local medical teams. We also take samples at establishments such as nursing homes. The Clinical initiative enables sample collectors to obtain information from the patient on their state of health and the context of their visit to the laboratory. Thanks to this information, the laboratory team can adapt care to the specific needs of the patient, according to their medical history. This will enable the pathologist to refine the diagnosis or advice given when validating the results. In the context of any research protocols ongoing within the laboratory, the initiative also makes it possible to inform the patient of the possibility of inclusion in a cohort. In this way, the Group deploys solutions and methods of organisation to participate in the development of decentralised clinical trials, allowing greater comfort, improved patient access to new therapies, and accelerated recruitment of patients in clinical trials, thereby promoting the development of tomorrow's therapies. ADAPT TO REIMBURSEMENT CONDITIONS AT COUNTRY LEVEL Healthcare reimbursement practices and regulations differ from country to country. For example, in France, Belgium and Luxembourg, services are financed by Social Security and mutual insurance. In other countries, particularly outside Europe, the conditions for the reimbursement of medical care do not include full social coverage. This ongoing quest to give access to diagnostic tools to as many people as possible leads us to work tirelessly on the efficiency of our supply chain and to maintain a close relationship with the authorities in order to offer the best possible solutions, especially in terms of price. Particularly in the African countries, but also in Italy, we focus on developing a diagnostic centre model that allows patients to have access to imaging and clinical pathology services in the same place.
23 'Following the first use cases described in our White Paper7, the first drone flight in Normandy with Cerballiance is a fundamental step towards the broader and above all more sustainable approach of our logistic mix for sample transportation. It illustrates our proactive approach to innovation, a real marker of the Group. By 2024, we want to identify precisely how drones could efficiently supplement our current model of transporting biological samples.' Jérôme Sallette, Scientific Director of Cerba HealthCare Cerba HealthCare conducts its first drone flights In February 2023, the Cerballiance and Cerba HealthCare Italia teams operated their first experimental flights for the transport of biological samples by drone6. This alternative to road transport, which has the advantage of a low carbon footprint, shortens time-to-results and improves the management of patients, regardless of where they live. 6. Find the test flight videos on the press release page: https://www.cerbahealthcare.com/en/ innovation-biological-samples-transportationcerba-healthcare-successfully-performed-firstflight 7.link to the White Paper 'Drones for medical logistics' published in collaboration with The Drone Office: https://www.cerbahealthcare. com/en/drones-medical-logistics-opportunitiesand-challenges
24 CONTRIBUTE TO THE HEALTH OF ALL Prevention: Cerba HealthCare participates in national prevention campaigns In France, the Cerballiance network and Laboratoire Cerba support national screening campaigns and encourage the population to get tested for a number of diseases: • Prescription-free testing with Au labo sans ordo: Since 1 January 2022, it is possible to have a HIV test without a prescription, 100% reimbursed with no upfront payment, on request and without an appointment at all medical pathology laboratories in France. Posters have been deployed in the Cerballiance network to encourage the population to get tested. The personnel have also been trained in this area in order to help raise patient awareness and encourage uptake. • Blue March: Blue March is the month of colorectal cancer, a disease that affects over 43,000 people each year in France, with nearly 120 cases diagnosed each day. Since 2015, Laboratoire Cerba has been responsible for performing colorectal cancer screening tests across France and all year round. • Human papillomavirus (HPV) self-sampling: It is estimated that regular screening could prevent 80% of cervical cancers. Cervical cancer screening by self-sampling is a reliable alternative when access to healthcare professionals is difficult. Laboratoires Cerballiance provide self-sampling kits free of charge. • National Kidney Week: With screening, kidney disease can be treated early and optimal renal function maintained for as long as possible, avoiding the need for transplant or dialysis and the complications of chronic renal insufficiency. The Cerballiance network communicates with patients to encourage everyone to get screened. Ketterthill in Luxembourg is also engaged in improving population screening. As part of the European Testing Week from 21 to 28 November 2022, Laboratoire Ketterthill enabled patients to get tested for HIV free of charge and without a prescription, rapidly and 100% anonymously in all centres of the network.
25 TOWARDS A ONE HEALTH APPROACH The aim of the One Health concept is to highlight the close links between the health of humans, animals and ecosystems. A MULTIDISCIPLINARY APPROACH The One Health concept promotes a multidisciplinary and global approach to health challenges and focuses primarily on infectious diseases – whether transmission is from animals to humans or vice versa, their emergence in connection with global changes, antimicrobial resistance and food safety. Thanks to our expertise in human, animal and environmental health, Cerba HealthCare is developing synergies between experts to advance the health of everyone, patients and animals alike. A GROUP AT THE FOREFRONT OF EPIDEMIOLOGICAL SURVEILLANCE In its capacity as reference laboratory in France, Laboratoire Cerba is at the forefront of epidemiological surveillance. The global scope of its activity makes it particularly informed of regional variations in viral genotypes, thereby providing accurate and fully up-to-date knowledge of the spread of viruses and optimal therapeutic strategies. Laboratoire Cerba is able to react very quickly to new infectious threats and develop new tests in a very short time to offer clinicians, patients and health authorities diagnostic opportunities that are rapid and reliable. Cerba HealthCare is therefore a trusted partner of the health authorities in monitoring emerging epidemics such as COVID-19 and infectious diseases such as measles or arthropod-borne viruses (dengue, Zika, chikungunya, etc.). INTERNAL AND EXTERNAL COLLABORATIONS Since 2022, webinars on the topic of One Health have been held by Cerba Vet College in collaboration with Laboratoire Cerba, the Cerballiance network, or partners such as Institut Pasteur. These training sessions, which in 2022 looked at toxoplasmosis, urinary tract infections and diphtheria, have interested a wide variety of professionals (general practitioners and specialists, pathologists, veterinarians, midwives, technicians, teacher-researchers, nurses, specialised veterinary assistants, etc.). In this way, they enable human and animal health professionals to respond jointly to the challenges posed by these infections, common to humans and animals. DEVELOP NEW EXPERTISE Other projects on human health in relation to our ecosystems are emerging within the Group. With regard to endocrine disruptors and pesticides, whose health effects evaluation represents a major public health issue, Laboratoire Cerba is developing tests to measure in patients levels of phthalates and bisphenol A (BPA) – endocrine disruptors that can induce effects on development and reproduction.
26 CONTRIBUTE TO THE HEALTH OF ALL MAINTAIN HIGH QUALITY OF DIAGNOSIS The Cerba HealthCare Group places continuous improvement at the heart of its Quality approach. OUR MISSIONS All of our collaborators work to maintain the highest quality of service, with the following main missions: • Guarantee the quality of our expertise every step of the way, from taking the sample to delivering the validated and interpreted result; • Produce a relevant result within an appropriate time frame, in line with the specific clinical situation of each case treated; • Satisfy our various stakeholders, including patients, prescribers, clinicians, healthcare facilities, private practice nurses, pharmacies, the pharmaceutical industry, biotech start-ups, NGOs and our subcontractors. In terms of quality control, regulations differ from one country to another. The Cerba HealthCare entities have therefore adopted quality management systems that are specific to each region. France is the world's most regulated country in the field of clinical pathology, governed by its Public Health Code. We must comply with the competence and quality management requirements of the NF EN ISO 15189 standard. Our laboratories are accredited by the French Accreditation Committee (COFRAC), enabling the same level of reliability to be recognised8. In 1998, Cerba was the first laboratory to be accredited and in 2021 it became a reference clinical pathology laboratory. In other countries, the entities are undergoing voluntary accreditation processes with the aim of bringing quality practices into alignment, such as in Italy, where accreditation is only mandatory in certain regions. In Belgium and Luxembourg, all our sites are ISO 15189 accredited. In Africa, the countries are committed to the ISO 15189 accreditation process. In addition, collaborators benefit from a full in-house medical training offer, which is easily accessible thanks to our e-learning platform, and increases year on year, particularly with the ‘Trainathons’ conducted in 2021 and 20229. IMPROVE PATIENT SATISFACTION The Net Promoter Score (NPS) is the flagship indicator for measuring the recommendations of our patients. It is already in use across the vast majority of the Cerballiance network. We are working to deploy and standardise this indicator internationally, to compare and monitor over time while allowing each entity to develop the satisfaction surveys most suited to their needs. 8. All Cerballiance laboratories and Laboratoire Cerba are accredited in clinical pathology according to the NF EN ISO 15189 standard. The list of sites and scopes is available at www.cofrac.fr 9. See chapter ‘Develop skills and employability’
27 ‘At Cerba HealthCare, the trust of our patients, prescribers, partners and correspondents is our priority. It involves the safety of patients and our staff, the satisfaction of our stakeholders – measured particularly by the NPS in France and Italy, and the examination of our customers' complaints. To continuously improve our level of service and the satisfaction of our patients, we work to harmonise practices and develop indicators such as the NPS.’ Céline Marcou Cherdel, Quality Director of the Cerballiance network Our communities of experts The experience shared by 4 communities of experts in microbiology, biochemistry, haematology and medically assisted procreation (MAP) creates synergies with a view to improving patient care. For example, MAP-community experts from the Cerballiance network together with vaginalmicrobiota experts from Cerba help to forge the Group's expertise in this theme of interest for the future, which could impact the success rate of in vitro fertilisation (IVF) by identifying patients with a favourable vaginal microbiota before implantation. ‘The medical communities are a real opportunity to improve the sharing of expertise, create enriching interactions to harmonise medical practices according to the latest current guidelines, and disseminate the latest scientific developments to always increase patient chances.’ Stéphanie Haim-Boukobza, Medical Director of the Cerballiance network
28 CONTRIBUTE TO THE HEALTH OF ALL DEVELOP SOLIDARITY Since 2015, our Institut Cerba endowment fund has been working to promote and develop solidarity-based health actions in France and around the world, alongside associations. THREE PILLARS OF ACTION PROMOTING SUPPORTIVE AND SUSTAINABLE CLINICAL PATHOLOGY Engage our collaborators Launched in 2019, a call for proposals is issued each year to all Group collaborators. In 2022, fourteen projects each received a grant of 2,000 euros, on a variety of topics such as hygiene, access to water, infection control and help for children in precarious situations. Examples of projects supported: • support for vulnerable populations in Lebanon; • support for children with type 1 diabetes; • prevention of breast cancer. Continue partnerships with NGOs and field associations In 2022, Institut Cerba supported UAMITIE, an association that works to find hosts for Ukrainian families, welcome their children in French schools and help the adults find work. Support research and innovation Institut Cerba attributes a number of awards, which include Thesis Prizes for the Pharmassilia and in 2022 a new award – the Prix Solidaire en Maïeutique [for solidarity in midwifery] with the French National College of Midwives (CNSF). Institut Cerba works hand in hand with Aix-Marseille University to reward students who reflect on the biology of tomorrow, and participates every year in the Pharmassilia – an event which rewards the best theses produced by students. The year 2022 marked the 50th anniversary of the Aix Marseille Pharmacy Faculty for which Institut Cerba supported the publication of a book entitled 1972-2022 – Faculté de Pharmacie d’Aix Marseille : 50 ans de rayonnement [1972-2022 – Aix Marseille Pharmacy Faculty: 50 years of influence]. A new prize for the engagement of midwives was awarded in 2022 by Institut Cerba and the CNSF: the Prix Solidaire en Maïeutique, which comprises a Research and Clinical component. The two winners each received a grant of 5,000 euros for their work. The awards aim to showcase and reward clinical and research initiatives already initiated in the gynaecological and reproductive health field, and which address solidarity, social inequalities in health, the fight against vulnerabilities, precariousness and/or access to care. The missions of Institut Cerba • Inform healthcare professionals; • Support and promote research and innovation; • Enable everyone, particularly the most vulnerable, to have access to high-quality clinical pathology.
29 Internationally: our collaborators are committed • In 2022, as part of a humanitarian-donation campaign for Ukraine, Cerba Research entity Viroclinics-DDL supported Giro555, an initiative that groups ten rescue organisations. • In 2011, Ketterthill established a partnership with Association Don de Moelle in Luxembourg, with the shared objective of informing and raising public awareness of the importance of bone marrow donation. This partnership has enabled the organisation of and participation in several promotional events: Donation Day, Telethon, Health Day, etc. • Cerba HealthCare Italia participated in the Elba Swim 647 race and supported the Abbracciamoli association that fights childhood leukaemia. • Cerba Research supports the Greater Gift Foundation by donating pentavalent vaccines (five different vaccines in one vial), supporting their global mission to help children in need.
DEVELOP HUMAN CAPITAL
31 3. DEVELOP HUMAN CAPITAL ‘Because "To take care of everyone is to take care of yourself"*, human capital is the major asset of Cerba HealthCare. Ensuring skills development and collaborator engagement is key for the company, which endeavours alongside this to provide a safe and inclusive environment with the best working conditions.’ Lionelle Mazoyer, Group Human Resources Director * Purpose of the HR Department
32 DEVELOP HUMAN CAPITAL OUR COLLABORATORS IN FIGURES (GROUP) 15,640 total workforce 15,378 average workforce 74% women 13,436 employees on open-ended contracts 1,575 employees on fixed-term contracts 626 independents ‘Human capital is the principal asset of Cerba HealthCare. Ensuring skills development and collaborator engagement is key for the company.’
33 DEVELOP SKILLS AND EMPLOYABILITY We want to offer our collaborators the opportunity to be the driving force behind their personal development and professional projects. KNOWLEDGE TRANSMISSION AND SUPPORT AT THE HEART OF HR ISSUES The Group's core activity is knowledge-based, and Cerba HealthCare has always invested in developing the skills of its collaborators. We have a continuous training policy adapted to the various professions of our collaborators throughout their career. Our efforts are also focused on career development, to ensure the long-term development of the company. In 2022, emphasis was placed on the creation of new training courses and the international deployment of the educational offer. Partnerships with schools Develop and retain collaborators The Bio-Managers programme with EM Lyon has been in existence since 2012, enabling current and future Group managers to enrich their skills in managing a department or business unit. Some forty collaborators have benefited from this programme, which includes more than 30 days of training with the school. In 2022, the participants in the fifth year group completed their training with a project to defend at the end. A sixth year group is planned for 2023. The Oxygen programme, co-constructed with the Paris Institute of Political Studies and launched at the beginning of 2023, is a tailor-made development programme to work on soft skills and embody leadership at Cerba HealthCare. Eight managers joined this first edition of the programme aimed at developing leadership attributes, by promoting curiosity and open-mindedness in particular. Promote the professional integration of young people There are numerous school partnerships, resulting in the reception of work-study students and trainees every year in our teams. In 2022, Laboratoire Cerba initiated a partnership with the Cergy-Pontoise University Institute of Technology (IUT) to adapt the curriculum of the new University Bachelor of Technology (BUT) in Bioengineering, particularly regarding the new analysis methods in molecular biology and physical chemistry. Several collaborators had the opportunity to work with the students, who also do part of their practical work at the laboratory site. Our training indicators for 2022 1% of the payroll dedicated to training 1 in 2 collaborators has received training 60 available e-learning modules 447 work-study students and 74 trainees
34 DEVELOP HUMAN CAPITAL Our corporate university: the Cerba HealthCare University Training is in the Group's DNA. Since the founding of the Cerba HealthCare University in 2016, we have enabled our collaborators to acquire skills through training in line with the company's strategy. With a digital platform, new training courses were created and deployed throughout the group in 2022, particularly on the subjects of personal data and cybersecurity. By the end of 2022, over 60 e-learning modules were available. A la carte catalogue training has also been developed with our service providers. Cerba HealthCare University is expanding in 2023 with a new catalogue of around fifty online modules, available in French, English and Dutch. This allows us to expand and internationalise our training offer. The themes of the new modules include diversity and inclusion, first aid, language learning and office automation tools. Medical training Each year, the 'Trainathon' initiative, launched in 2021, aims to mobilise pathologists, laboratory technicians and medical secretaries over a period of one week in order to produce, in-house, training courses for the Group’s French-speaking collaborators, which can be accessed from the Group e-learning platform. In 2022, 14 collaborators came together for the second edition of the 'Trainathon' in order to produce the content of the 13 new courses which reinforce the medical training offer. The subjects of these courses include allergies, the thyroid, and maternal-foetal infections. Raise awareness and train collaborators in CSR In 2023, a CSR training plan was rolled out across all Group entities. This consisted of: • An e-learning module on the foundations of sustainable development and the Cerba HealthCare CSR strategy, for all collaborators and available in French, English, Italian and Dutch. • Virtual classes for 300 top managers, focusing on their operational contribution to CSR, sustainable procurement and reducing our environmental impacts. • Tailor-made training for members of the Group Management Committee on the interconnection between the financial and extrafinancial performance of companies. In addition, the Group shares a short video every 2 months with all collaborators highlighting a CSR theme.
35 Cerba Vet College: a training organisation to support collaborators and external medical staff Cerba Vet College is a continuoustraining organisation that offers veterinarians practical sessions to update their knowledge in many specialist areas. It offers face-toface and remote programmes, as well as weekly webinars. The trainers, veterinarians from Laboratoire Cerba Vet and external veterinary specialists, attract a diverse audience thanks to interactive sessions, practical cases and Q&A sessions. Beyond the format, it is the diversity and complementarity of the expertise offered as well as the quality of the content that play a decisive role in the success of Cerba Vet College. As such, many themes were addressed in 2022, such as cardiac markers, emergency techniques in surgery and pulmonary diseases in dogs. SINCE ITS LAUNCH IN 2018 150+ webinars have been held live 30+ trainers 10,000+ vets have followed these webinars 82.14 NPS for the webinars in 2022 Tailored training for supervisors and new collaborators The role of supervisor is open to multi-skilled technicians or nurses, and to medical secretaries. This is a local-management position, created to improve site activity coordination and staff facilitation. The Supervisors programme, created in 2021, provides operational tools and methods to mobilise teams on a daily basis and reinforce managerial skills, to help them address the various everyday challenges they are likely to face in the field. To date, nearly 200 supervisors have received this training. Finally, induction days are held in order to welcome new collaborators under the best possible conditions, whether at Group or regional level... For this occasion, they are offered a certain number of presentations and activities: presentations on the various activities of the group, institutional presentations, HR and a visit to a technical platform. Mobility In order to fill vacant positions more easily and to ensure the versatility of its collaborators, the Group also focuses its efforts on internal mobility initiatives. In 2022, 96 collaborators made use of such initiatives in France or abroad.
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