A doctor said he has seen a rising number of people turning down free flu jabs alongside an increase in "general anti-vax" sentiment.
Most eligible adults will be able to get a free flu vaccine on the NHS from 1 October but there has been small falls in the number of over-65s in the West Midlands getting the jab between 2023-24 to 2024-25, according to official figures.
In the near decade he has been a GP, Birmingham doctor Arun Ahluwalia said he had seen an increase over the past few years in the number of people refusing it.
"Even in that brief time, I've noticed there are far more people declining the flu vaccine who I think wouldn't have declined it before, which is a real shame," he said.
Some of those patients have always been against vaccines, said the GP, but he added some have really changed their position in recent years.
They can be quite hard to convince or discuss vaccinations with, he stated.
"When I've asked them for reasons why they don't want to get vaccinated, I get some interesting responses back, none of which I feel are evidence-based," Dr Ahluwalia said.
Research from the UK Health Security Agency (UKHSA) found 20% of parents surveyed in 2023 said they had come across information online that made them worried about vaccines, a sharp jump from just 6% the year before.
Across local authorities in the West Midlands, figures from the agency for flu vaccines, given to over-65s patients registered with their GP, showed there were declines in every parts of the region between 2023-24 and 2024-25.
The biggest drops, in percentage terms, were in Sandwell and Walsall, of nearly 5% in both cases, to 61.4% and 69.7% respectively.
Overall, across the West Midlands, the percentage declines ranged from 2-4% with the lowest falls in Shropshire, Solihull and Warwickshire.
Although Dr Ahluwalia said he could not say what had caused the change in attitude among some patients, he thought social media played a part.
"I don't see a lot of push-back on that, saying 'actually, what you've heard might be incorrect' and it's better to discuss this with a trusted health professional," he said.
The GP, who works in east Birmingham, said he made a personal point of speaking to vaccine refusers at his surgery.
"Everyone has the right to make their own decisions, I'm just interested in making sure people are as fully informed as possible before making a decision about what goes in their body or not," he added.
The threat from getting seriously ill from flu and Covid-19 is all too real, said Roz Lindridge from NHS England.
Vaccinations "could keep you out of hospital this winter", stated the health boss, who has responsibility for vaccinations in the Midlands.
People are offered a free NHS flu vaccine if they are:
Children and pregnant women were eligible for a flu vaccine from 1 September, with other eligible groups able to have one from 1 October.
Appointments for those aged 18 or over can be booked at a pharmacy online or in the NHS App, while pharmacy vaccination appointments can also be booked for children aged between two or three years old.
For those not eligible for a free jab, they may be able to pay for one at some pharmacies, the NHS said.