This study uses the Health Belief Model (HBM) to analyze the narrative constructions and sentiments of the most retweeted tweets about COVID-19 vaccines. Large-scale data and qualitative textual analysis revealed that tweet dissemination is influenced by perceived risks and benefits, while the tweet format (narrative vs. non-narrative) had no significant effect. Personal stories gained more shares than cultural stories, and high-benefit narratives received more retweets than low-risk ones. Tweets with highly perceived benefits elicited positive sentiments, highlighting implications for effective health communication on social media. Theoretical implications for the HBM model and crafting effective intervention health messages were discussed.