Social influence versus fear in COVID-19 vaccine acceptance: insights for health marketing communication

Purpose This paper examines how fear (of COVID-19 and of COVID-19 vaccine side effects) and social influence jointly and individually affect the intention to receive the Oxford–AstraZeneca vaccine. This study aims to fill a gap in health and pharmaceutical marketing research by clarifying the relative importance of emotional versus social drivers of vaccine acceptance. Design/methodology/approach A quantitative survey of 600 adults residing in Spain was conducted using quota sampling for age and gender (gender quotas were partially unmet). Respondents evaluated fear of COVID-19, fear of vaccine side effects, social influence and intention to vaccinate using established scales. Consistent partial least squares structural equation modelling was used to assess measurement validity and to compare three models: a joint model including all predictors, a fear-only model and a social-influence-only model. Findings Fear of COVID-19 has a positive effect on vaccination intention, while fear of vaccine side effects has a negative effect. Social influence shows a strong positive effect and is the most influential predictor across all models. When considered jointly, social influence substantially reduces the explanatory power of fear, indicating that trusted individuals and institutions shape vaccination decisions more decisively than emotional responses. Research limitations/implications Results are limited to Spain and to the Oxford–AstraZeneca vaccine during a specific time period. Replication in other countries, vaccine types and socio-economic contexts is recommended. Nevertheless, the findings may be particularly relevant for contexts similar to that generated by the COVID-19 pandemic, in which both the disease and the potential effects of the vaccine were largely unknown, resulting in levels of uncertainty substantially higher than those associated with well-established diseases and vaccines, such as seasonal influenza. Practical implications Health communication and pharmaceutical marketing strategies should prioritize credible institutional messaging and trusted influencers rather than fear-based appeals. Addressing misinformation and strengthening institutional trust are essential. Originality/value This study offers an original analytical focus by providing the first comparative analysis of joint versus individual effects of fear and social influence on COVID-19 vaccination intention, offering new insights for health marketing strategy design.