In 2019, additional interactive food safety training modules were developed and launched on all of our ships. New innovative training videos using a combination of live action and animation have been added to the training library.

All of our ships that call on U.S. ports are subject to unannounced, twice-yearly public health inspections from the Center of Disease Control (CDC) – Vessel Sanitation Program (VSP). In 2019, two of our ships received a perfect score of 100 and one of our ships received a failing score of 77 in July. Immediate corrective actions were implemented and when the ship was inspected again in October it received a score of 99. In 2019, four of our ships received a perfect score from the Public Health Agency of Canada (PHAC).

Our Care Team continues to provide compassionate care for guests and crew in the event of an emergency while on board. Care Team employees have received specialized training on how to sensitively and appropriately support guests, crew and their families during an emergency. They are available 24 hours a day, seven days a week and respond to a variety of guest and crew emergencies, primarily medical related situations, and are dispatched to locations throughout our cruising regions to provide personalized support and assistance as needed to all of our brands.

Enhancements to our fleetwide standard electronic health record (EHR) platform were made and SeaCare now helps support many aspects of our medical operations and services.

In 2019, a worldwide increase in measles cases was widely reported with significant outbreaks occurring in the United States, Europe and the Pacific regions. We proactively provided our ships with additional procedures and guidance for the prevention and control of measles cases on board including:

• Recommendations for crew and passenger vaccinations.

• Specific health information and advice.

• Measures to ensure identification and management of any possible measles cases and their close contacts.

• Information on country-specific requirements and control measures.

In 2019, no significant health impacts from measles were reported on any of our ships.

The 2018 executive health assessment pilot program provided by the clinic and medical wellness facility at the Arison Maritime Center (known as CSMART) for Deck and Technical Officers was adopted by all our Operating Lines. This program promotes long-term health improvements among our officers over time.

Our entire suite of comprehensive medical procedures was reviewed and improved in 2019. The key enhancements included:

• Providing a more user-friendly procedure structure and formats to help effective use by our medical teams.

• Updating clinical guidance and requirements in line with recognized international healthcare best practices.

• Providing additional and enhanced fleetwide procedures and guidance covering issues such as clinical pathways, the provision of medical assistance ashore, use of X-rays, management of controlled drugs, onboard emergency medical response, and the management of measles cases.

As members of the Cruise Lines International Association (CLIA), we regularly discuss health matters and communicate with all member lines to share best practices. In 2019, we participated in several CLIA health programs and initiatives such as:

• Consultation on changes to the ANVISA Brazilian ship sanitation manual.

• The development of European Union Healthy Gateways joint action provisions for grading of ship inspections.

• Proposals to provide a new score grading approach to ship inspections conducted by the U.S. Vessel Sanitation Program.

In 2019, we completed the fleetwide rollout of a new health, environment, safety and security (HESS) event reporting system. This platform has allowed us to standardize our HESS event reporting and analysis capabilities across the entire fleet.