More than one in three people in Greater Manchester at serious risk from flu were not vaccinated against the virus last year.
Eligible patients are now being urged to get their jab as soon as possible, with concerns that a big flu season is going to hit the NHS in the coming months.
Health minister Sajid Javid has warned there is "a lot less immunity" because of the Covid restrictions in place last winter, with fewer people catching the virus meaning fewer have built up a defence.
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There are also concerns that this year’s flu jab may not be as effective as usual, because laboratories have not been able to collect all the data needed during the pandemic.
This, combined with ongoing pressures from Covid-19, means the UK is facing what the NHS fears will be a “very difficult winter”.
In response, the government is rolling out the biggest flu vaccination programme in NHS history, which will see 35 million people across England offered a jab or nasal spray vaccine.
Speaking to Sky News earlier this month, Mr Javid said that, for those over 50, "getting your flu jab is going to be as important as having your Covid jab".
However, despite a record number of people getting the vaccine last year, even more will need to come forward to accept it if the government is to meet its ambitious targets.
Figures from Public Health England reveal that more than 331,200 people in Greater Manchester considered to be at risk of death or serious illness went unvaccinated last flu season.
That works out as 34% of all people in the area who are considered to be in danger of developing a life-threatening illness such as pneumonia if they catch the flu.
As well as adults and children with existing health conditions - such as chronic liver, heart or respiratory disease, or conditions such as immunosuppression and diabetes - that includes people over the age of 65 and pregnant women.
In total, there were 960,829 people considered at-risk in Greater Manchester between last September and the end of February this year, of whom 629,620 received the vaccine.
Those aged over 65 were the most likely to be vaccinated, with 80% of all people in this age group getting their flu shot last year - although that still left more than 93,200 people unprotected.
That's also below the government’s target to have 85% of all 65-and-overs vaccinated this flu season.
Meanwhile, across those aged under 65 in our area who fall into a clinical risk group, the uptake was much lower - around 52% received their vaccines, leaving more than 220,200 unprotected.
Pregnant women were the least likely of those at risk to get their flu shot, with an uptake of just 44%, meaning nearly 17,800 were left vulnerable - although as there are challenges to calculating uptake in this group, PHE say it is likely an underestimate.
The ambition is to have at least 75% of both pregnant women and at-risk people aged under 65 vaccinated this year.
Since 2013-14 the vaccination programme has also been extended to all two and three year olds in order to help prevent the disease from spreading.
While 58% of the small number of at-risk three year olds and 48% of at-risk two year olds were vaccinated, that meant nearly 1,200 did not get their jabs.
The vaccination rate was even lower for children not considered to be at particular risk.
Just 55% of three year olds and 52% of two year olds in Greater Manchester not in a clinical risk group were immunised last year, leaving more than 32,800 susceptible to catching and passing on the flu.
The target for this year is to have at least 70% of all preschool children aged two and three years old vaccinated, with most GP practices aiming to achieve a higher figure.
In response to the pandemic, the vaccination programme was extended last year to include household contacts of those on the NHS Shielded Patient List, Year 7 aged children, more health and social care workers, and those aged 50 to 64 - although figures on uptake amongst these groups are unavailable.
This year, the programme is also extending even further, to include all children aged two to 15, people in long-stay residential care homes, and carers.
So far the programme has been plagued by delays and cancelled appointments, with a shortage of HGV drivers hampering supplies of the vaccine.
However, recent updates suggest deliveries will take place this week, meaning the programme should soon be underway.
But there are challenges when it comes to delivering these flu jabs alongside Covid vaccinations and booster jabs - with one member of the Joint Committee on Vaccination and Immunisation (JCVI) saying the logistics “won’t be easy”.
Saffron Cordery, deputy chief executive of NHS Providers, said: “No one should be under any illusions about the scale of the task we face in the coming months as we head into what looks like being a very difficult winter.”
