Grand Prix
Category A02. Healthcare
Idea Creation ÅKESTAM HOLST Stockholm, SWEDEN
Production ÅKESTAM HOLST Stockholm, SWEDEN
Production 2 BKRY Stockholm, SWEDEN
Post Production BKRY Stockholm, SWEDEN
Name Company Position
Joakim Khoury Åkestam Holst Art Director
Simon Lublin Åkestam Holst NoA Copywriter
Martin Noreby Åkestam Holst Art Director
Rickard Beskow Åkestam Holst NoA Copywriter
Michal Sitkiewicz Åkestam Holst NoA Art Director
Magnus Jakobsson Åkestam Holst NoA Creative Director
Lina Engler Åkestam Holst NoA Account Director
Linda Bryttmar Åkestam Holst NoA Account Manager
Jennie Strinnhed Åkestam Holst NoA Account Manager
Karl Wikström Åkestam Holst NoA Strategist
Henrik Adenskog BKRY NoA Producer
Nisse Axman BKRY NoA Motion Designer
Anna Forsberg BKRY NoA Final art
Sarah Frey BKRY NoA Producer
Eskil Lundberg BKRY NoA Motion Designer
Kalle Peterz BKRY NoA Web developer
Alex Picha BKRY NoA Digital producer
Digge Zetterberg Odh NoA PR Director


We sought to draw attention to sustainability within the pharmaceutical industry. This is important from a societal perspective – driving real improvements – and from a brand perspective: to advance our reputation for responsible business practices and sustainability efforts, drive purchase intention, and improve brand health. Objectives: Generate attention and campaign liking… …in order to gain recognition for our sustainability efforts and shape consumer attitudes towards the brand… …to drive purchase intention… …and champion real and needed change in the pharmaceutical industry.

Summary of the work

Context Hyderabad in India is the world’s biggest manufacturing site for medicine. More than 50% of India’s exports of medicine are produced here, and make up the significant share imported to the US, Europe, and Sweden – our home market. Due to lack of environmental oversight, many factories in Hyderabad dump their waste into nature. This means that medicine we take in wealthy countries makes people sick and pollutes the environment in other parts of the world. Apotek Hjärtat, Sweden’s biggest privately owned pharmacy, has been working actively with sustainability since the start in 2010. In 2019 we decided to do our part in making pharmaceuticals more sustainable, and make sure the medicine we sell doesn’t harm others, even though it meant going against our own industry. Creative idea We collected 100 liters of water near pharmaceutical factories in Hyderabad in collaboration with Sweden’s most outstanding laboratories, RISE (Research Institutes of Sweden). We extracted active substances into a new kind of medicine: Sordidum Pharmacum - a deadly cocktail from pharma-polluted water. The new ”medicine” was used in an integrated campaign (print, TVC, OOH, SoMe) to awaken the public and generate debate. We sent pills to politicians with a medication package insert that states what we found in the water, the effects, and what we wanted to be done; adding sustainability as a criteria in the procurement of pharmaceuticals on a nationwide level. We also invited all Swedish pharmacies to join us in launching the world’s first label for sustainable pharmaceuticals. Strategic core We packaged an abstract problem as a physical product, demonstrating the danger posed by pharmaceutical pollution to stimulate attention and debate. Letting people face the fact that medicine might be poisoning people on the other side of the world, generated the necessary outrage and engagement to create real change. Traditionally, procuring medicines is about lowering costs to benefit patients and healthcare facilities, with no thought towards sustainability. Our hope of changing that was to show how low cost comes with a high price. Execution Water was collected from the vicinity of pharmaceutical factories. RISE performed examinations and extractions. The result: 60 grams of substances turned into Sordidum Pharmacum pills. They were shown at our pharmacies, sent to politicians and used in all our activities. Our website informed the public on the issues and the lack of a sustainability criteria in procurement. They could download the report and find out how to influence politicians. We spread the initiative via long and short films, print ads in Sweden’s largest newspapers and through PR. In addition, we invited our competitors to join in launching a sustainability label based on our precursor “Follow-Your-Heart”. It worked. The campaign was well received and garnered national attention. Apotek Hjärtat gained recognition for sustainability and achieved business goals. Swedish pharmacies launched a shared label for sustainable pharmaceuticals, two of the world’s largest pharmaceutical companies contacted Apotek Hjärtat to see what they need to change, and Swedish parliament passed a bill promoting environmental criteria in procurement.

Engagement & Awareness

The campaign stirred the attention of Swedish consumers and international media, including Times of India – the world’s second biggest newspaper in English and the third largest newspaper in the country: https://timesondia.indiatimes.com/city/hyderabad/now-a-pill-from-polluted-hyderabad-water/articleshow/71964339.cms The campaign received heavy coverage in Swedish national news: https://www.svt.se/nyheter/inrikes/svenska-lakemedel-forgiftar-vattendrag-i-asien-omojligt-att-stalla-miljokrav-palakemedel- ett-akut-problem Advertising recall peaked. Our work was seen by 1/3 of the population, drove 1 in 10 Swedes to visit the campaign site and generated 10 000 downloads of the report. ”A hard pill to swallow” turned out to be the most liked campaign in the history of the brand, with a liking of 61% within the population. 49% agreed that ”the campaign speaks to me” 57% agreed that it ”awakens my curiosity” 46% agreed that ”I was inspired” 39% agreed that ”I will talk about the advertising” Campaign evaluation revealed a reaction pattern that is quite unusual: a strong combination of negative emotions – anger, discontent, sadness, worry – combined with the aforementioned record-breaking liking. This was a true ”high risk, high reward” campaign, transforming strong negative emotions into our desired response.

Social Behaviour & Insight

Sustainability communication is complicated. It is all too easy to end up with campaigns centered on problems that are too big or abstract to engage a broad audience, vague claims, overpromises, or lots of talking but no walking. We saw honesty as a path to change. Our challenge was to get people to care about a problem in another part of the world. Condensing distant hazards into a physical pill was our way of exposing an obscured issue and make it both tangible and personally relevant. It worked. Our initiative generated more than 10 000 downloads of the lab report with details on the substances found in the water sample. In campaign evaluation, 11% of our broad audience stated they had visited our site hardpilltoswallow.se.

Brand Affinity & Sentiment

With record-high liking, ”A hard pill to swallow” propelled consumer attitudes, brand affinity, and our sustainability reputation. Campaign evaluation indicates how impressive shares of the target group gave credit to Apotek Hjärtat for drawing attention to the issue: 64% agreed that ”The brand takes responsibility for the environment” (goal 45%) 62% agreed that ”The brand takes responsibility for people and the community” (goal 40%) 60% agreed that ”The brand cares about the lives of people” (goal 40%) In the quarter following the campaign, brand preference jumped nearly 50% among Apotek Hjärtat’s primary target group.

Sales Success

The campaign prompted 42% of the target group to express a willingness to recommend Apotek Hjärtat, and a 41% intention to visit one of their pharmacies. 37% intended to buy more sustainable pharmaceuticals in the future. In a quarter of brand tracking, ”last visited pharmacy” increased by about 30% among the primary target group for the brand.


With heavy coverage in Swedish news, our campaign was seen by 1/3 of the population, prompted 1 in 10 to visit the campaign site and generated 10 000 downloads of the lab report detailing the polluted water sample. In India, the issue was covered by the world’s second largest English newspaper - The Times of India. The brand benefitted significantly, with increases in consumer attitudes and intentions. Even more amazingly, ”A hard pillow to swallow” really did fulfill our wildest expectations as a catalyst for real change. More than a third of consumers expressed an intent to buy more sustainable pharmaceuticals. All major Swedish pharmacies agreed to launch a shared label for sustainable pharmaceuticals, based on Apotek Hjärtats original label. Two of the world’s largest pharmaceutical companies have contacted Apotek Hjärtat to see what they need to change to receive the label. Swedish parliament passed a bill promoting on environmental criteria in procurement. By turning pollution into a pill we made the problem real enough for people to react and politicians to act, and revealed the problems hidden under the surface of the pharmaceutical world.

Discounting Factors

Apotek Hjärtat did not communicate other sustainability efforts during this period. No other news put the issue of global pollution surrounding pharmaceutical at the center of the debate. We feel confident attributing the attention and ensuing debate and reputation effects to the campaign.