To determine if advocacy of influenza immunisation by community pharmacists would affect vaccine acceptance among patients at risk of influenza, a randomised, placebo‐controlled trial was conducted in three pharmacies. Patients receiving certain medications for heart or lung disease or diabetes, or receiving non‐steroidal anti‐inflammatory drugs and who were at least 65 years old, were randomly assigned to receive either messages explaining the risk of influenza and availability of vaccine or recommending household poison prevention measures. All patients were surveyed by mail regarding behaviour and opinions related to influenza and influenza vaccine.Of 125 previously unvaccinated recipients of vaccine‐advocacy letters, 39 were vaccinated (31.2 per cent), compared with 24 of 134 control subjects (17.9 per cent), a difference of 13.3 per cent (P=0.013). Unvaccinated patients were 1.74 times more likely to be vaccinated after receiving vaccine recommendations and information than were control patients. In this setting, community pharmacists increased vaccine acceptance by advising patients of their personal risk and describing where to be vac