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Preempting Digital Fatigue in the Post-Covid-19 Era​

Executive Summary

In 2020, pharma organizations increased their digital communications with healthcare professionals (HCPs) as it became a necessity overnight due to the pandemic. After Covid-19 hit globally in March 2020, the number and frequency of digital touchpoints grew exponentially in 2020 and 2021. According to Veeva, approved emails sent increased by >8 times in 2020 and the number of representative-to-HCP virtual meetings increased by >6 times since the start of pandemic.
With brands and companies sending multiple emails in a short period to HCPs, they may get exhausted, potentially leading to digital fatigue setting in for the overstressed warriors of our society. At this stage, they are more likely to end up unsubscribing from the brand promotional activities. This study aims to determine whether the increase in digital touchpoints has led to an increase in digital fatigue. Specifically, it investigates whether the increase in promotional emails delivered has an impact on unsubscription or opt-out rate.
To test the hypothesis that an increase in emails sent leads to higher unsubscriptions, we analyzed >7.9 million emails from 15 email campaigns representing multiple therapy areas executed in 2020 and 2021. The analysis indicated that more emails do not lead to an increase in email unsubscriptions, contradicting the hypothesis.
The results show that HCPs have adopted to increasing digital touchpoints over emails, and it has not led to digital fatigue. On this basis, we analyzed additional email data sets to determine the ideal email volume, frequency, and quality factors that pharma brands can leverage when designing future email campaigns for higher engagement rates and keep HCP fatigue in check.

The digital fatigue

Digital fatigue is the state of exhaustion and disengagement that occurs among people who are exposed to many digital channels and content across devices concurrently.

Be it an app or social media notification on our phone, SMS notification on our smartwatch, or an email notification on our laptop, there is an endless distraction that is changing our behaviors. Our desire for "being connected" or "new" is causing us to switch topics regularly, and hence, our attention span is further decreasing and getting divided, resulting in emotional and mental exhaustion or fatigue.

Importance of digital fatigue

The impact of digital and remote channels versus sales representatives has grown by 30% in 2021 compared with 2020 (Figure 1). The impact is more likely to continue in the same trend and grow in the future. Brands are expected to increase pharma advertising spending driven by digital channels. Pharma advertising surpassed $11 billion in 20211 from $6.6 billion in 2020.

As brands continue to execute more campaigns across digital channels, our focus is to measure the true state of HCP–pharma digital engagement. This will help derive insights to improve campaign effectiveness, improve HCP-pharma experience landscape, and build long-term relationships.

Figure 1. Impact of Digital Channels on Prescriptions Relative to Sales Representative Detail

Digital fatigue from emails

Pharma brands created content at a rapid pace to meet the huge demand, augment and supplement efforts of sales representatives across digital channels. This led to multiplication of content created by 4 times in just a year (Figure 2; April 2020 to March 2021). We observed that the volume of content produced in the first 6 months of 2021 has surpassed that of the entire year of 2020.

Figure 2. Volume of Content Created

In this report, we analyzed email campaign performance as it was the most-used channel among the digital communications. We witnessed an exponential growth of 50% in email content creation in just 2 quarters in 2021 versus 2020 (Figure 3).

Figure 3. Content Created by Type in 2020 and 2021 (6 Months)

According to Veeva, there was an >800% increase in Veeva-approved emails sent in 2020.

The email unsubscription rate is a great indicator of digital fatigue as it indicates the percentage of users who have opted out from the mailing list after an email campaign.

We analyzed 15 email campaigns that delivered >7.9 million promotional emails across multiple therapy areas and objectives from April 2020 to August 2021. The analysis shows (Figure 4) the following findings:

Figure 4. Email Unsubscription Rate

Period 1: Between April and May 2020, during the initial days of Covid-19

Emails delivered jumped 6 fold in May 2020 to 298,592
Number of emails delivered per HCP grew from 1.2 in April 2020 to 1.4 in May 2020
As HCP received more emails, the unsubscription rate fell from 2.22% to 1.4%

Period 2: Between June 2020 and August 2020, when the world witnessed shutdowns due to the pandemic, we observed the following findings:

Pharma brands amplified email campaigns to new levels. Emails delivered increased from 298,592 in May 2020 to an average of 445,089 emails per month (June 2020–August 2020)
The volume of emails HCPs received also grew from 1.4 in May 2020 to an average of 1.8 emails per HCP each month during this period
The unsubscription rates further dropped to 0.57% and reduced to 0.26% in August 2020 indicating higher adoption levels

Period 3: In the next 12 months between September 2020 and August 2021 as the pandemic restrictions started to ease, we observed the following findings:

An average of 360,000 emails were delivered to HCPs each month
The number of emails each HCP received remained high (1.8-2 emails/ HCP) each month with a couple of exceptions. However, the email unsubscription rate further decreased to an average of 0.20%
The unsubscription rate is at par with other industries such as financial services (0.20%), IT/software services (0.20%), and professional services (0.20%)2


Although there has been an increase in emails delivered after the onset of Covid-19, the unsubscription rates have reduced continuously. This indicates that the HCPs have adopted to increasing email communications and are not facing any signs of fatigue.

Recommendations for pharma brands

We analyzed another set of >6.2 million marketing emails sent to 436,000 HCPs in 2020 to determine best practices that pharma brands can leverage when designing promotional email campaigns. The analysis showed the following findings:

1. Email volume impacts engagement

More emails delivered do not correlate with higher engagement rates. Brands need to find a balance based on the therapy area and geography to sustain engagement. Our analysis (Figure 5) shows the following findings:

Figure 5. Click rate versus email delivered (2020—2021)

More than 80% of the audience opened at least 3 to 4 emails when >10 emails were delivered. Set up campaigns with at least 10 to 15 emails to drive higher engagement
Campaigns that targeted HCPs with 10 to 15 emails witnessed a higher engagement rate (an average >3%) than those that deployed a ≥16 or more emails (an average <2% engagement rate)

2. Right timing matters to avoid low-engagement levels

Almost half of the subscribers mark emails as spam because they are too frequent3. Giving them the option of choosing the frequency is a great way pharma brands can drive higher engagement rates. Based on the analysis (Figure 6), we observed the below findings:

Figure 6. Email click-through rate versus frequency of emails delivered

HCPs showed lower engagement rates when promotional emails were delivered more than once a week
The click-through rate was more than twice when promotional emails were sent within 4 to 6 weeks of one another versus weekly or daily. This excludes emails triggered by organic interactions of HCPs with other brand properties

Figure 7. Indegene survey on HCP preferences on frequency of interactions

A survey (Figure 7) by Indegene showed that more HCPs preferred to receive email newsletters on a monthly basis
HCPs preferred expert-led sessions, such as webinars, every quarter. Emails, websites, social media posts, and mobile app-based communication were preferred every month (Figure 7)

3. Quality is more important than quantity

HCPs are more digitally native today than in the last 5 years. As brands rushed to deliver content over digital channels post Covid-19, not much attention was given to the quality of content. More than 55%4 of the HCPs across the world are overwhelmed by the content they receive. Hence, there is a lot of scope for improvement.

Below are some of the recommendations that pharma marketers can leverage to improve the quality of the content:

Creating outstanding content starts with understanding the customers' needs and where they are in the conversion journey. This helps to create a comprehensive content strategy that brands can leverage to drive disease and product awareness across the product lifecycle
HCPs prefer content that is relevant, simple, and impactful, which can ultimately differentiate the product/brand from the competitors
HCPs prefer more content based on education, new clinical data, and patient materials (Figure 8) than marketing/promotion-led content that they receive. The study also indicates that both general practitioners and specialists prefer medical education; specialists also hold a high value on new clinical data. The lack of content related to clinical practices—such as guidelines, patient support, and clinical cases—results in poor engagement

Figure 8. HCP content preference versus received content

Base: 486 interactions between US HCPs and pharmaceutical firms

Source: DT Consulting/Aptus Health

4. Design defines the overall experience

For email campaigns to be effective, that is, to be noticed, opened, read, or acted upon, the design must take a front seat. It is about not only having attractive looking templates but also following a structural design. Following are the best practices that can help brands grab HCP attention:

Even before emails are opened, the subject lines determine a large part of whether a message is even worth opening. Compelling and clear subject lines are the need of the hour. Brands need to focus on the value proposition that shows HCPs what to expect from the email
Once the email is opened, it is crucial to keep the audience's attention and interest. HCPs have tons of other things to do, and their time is precious. Hence, they lose focus if the emails are long, text-heavy that require multiple scrolls. Keep them short, crisp, and have the necessary call to actions to guide the reader to the relevant pages
Have clear and identifiable call to action buttons that ensures HCPs are driven to the right pages
A/B testing should be done on every aspect of the email campaign right from content, time of delivery, subject line, call to action buttons and even call outs. Testing uncovers insights that help optimize the email campaigns further driving higher engagement rates


During Covid-19, digital touchpoints rapidly increased, which can cause digital fatigue to set in. Among the digital channels, we analyzed emails to determine digital fatigue since emails was used extensively. Email unsubscription rate reduced consistently post the onset of Covid-19 indicating the high levels of channel preference.

Overall, pharma brands will need to re-evaluate email strategies to keep digital fatigue in check. Incorporating adequate checkpoints will help measure campaign effectiveness. Marketing teams will need to find a balance between the volume of emails, frequency, quality of content, and design for campaigns to be impactful by testing them constantly. Adopting mature strategies such as modular content can accelerate brands to execute email campaigns at speed and scale. By integrating HCP personas, campaign performance data along with artificial intelligence, and machine learning models, brands can unlock new insights that can further help personalize and predict behaviors. This will be the key to identify digital fatigue that can drive new levels of engagement.

The content of this publication is based on the analysis and findings of the authors and in no way is complete or associated with any warranty as to the accuracy, completeness or currency of the content. The contents of this document are the authors’ own and do not reflect the view of Viatris or any of its subsidiaries. No Viatris data has been leveraged in the analysis that led to this report.


Pharma US Digital Ad Spend Up by 242% YoY in the First Two Months of 2021 | News | FOCUS ON Business https://focusonbusiness.eu/en/news/pharma-us-digital-ad-spend-up-by-242-yoy-in-the-first-two-months-of-2021/4187
Email Marketing Benchmarks and Statistics for 2021 | Campaign Monitor  https://www.campaignmonitor.com/resources/guides/email-marketing-benchmarks/
Email Marketing Research Chart: Why subscribers flag email as spam | MarketingSherpa https://www.marketingsherpa.com/article/chart/why-subscribers-flag-email-as-spam. Accessed October 1, 2022.


Ashish Jajoo
Ashish Jajoo
Gaurav Kapoor
Gaurav Kapoor
Nikin Kovilakath
Nikin Kovilakath
Deelip M A
Deelip M A