Vaccination has removed terrible scourges from human ken. Smallpox was, for most of human history, a deadly killer. Vaccination has eliminated the threat. Parents used to dread the advent of summer, when polio seemed to lurk in the hot air, poised to strike down young people with paralysis that could blight their lives forever. Vaccination lifted that pall.

Today there are vaccinations against all kinds of childhood diseases, sexually transmitted diseases, and against seasonal afflictions like the flu.

The ubiquity of vaccines for all kinds of diseases has created some cultural backlash. While there are ardent “anti-vaxxers,” most of the concern raised about vaccination is not extreme — but people do have questions.

“I wouldn’t say I have anybody who flat-out refuses vaccination,” Dr. Eden Miller of High Lakes Health Care in Sisters told The Nugget.

Dr. Miller advocates a measured and individualized approach to vaccinations — and to the illnesses they are intended to prevent. Families should act upon their needs and requirements and upon solid, evidence-based information.

“Vaccination should benefit the herd, but still be individualized,” she said. “We should not be fearful of illness or fearful of vaccination. There’s somewhere in between… We still have to have room for freedom.”

Some people worry about side-effects of vaccinations. The concern that has received the most attention is a claim that vaccines cause autism — a claim that has been thoroughly and repeatedly debunked. Most people’s concerns are less dire than that — and they’re not entirely unfounded. Some people can have a negative reaction to a vaccine and feel pretty cruddy. But serious side-effects are very rare, and pale in comparison to the serious health risks of contracting measles or pertussis or other childhood diseases.

For some people, it’s not the vaccines themselves so much as the intensity of the amounts and varieties recommended for kids that raise concerns. The Centers for Disease Control (CDC) recommends getting 29 doses of nine vaccines (plus a yearly flu shot after six months old) for kids aged 0 to 6.

Dr. Miller, again, recommends an individualized approach based on what works for a family. She notes that early, extensive vaccination is a widespread protocol because in many environments doctors simply don’t know when they’ll see a patient again — when they’ll have another opportunity to vaccinate.

In a community environment where patients and families can develop a relationship and a history with their doctor, it may make sense to hold off on some vaccinations.

For example, if a newborn isn’t going to be out in the world and potentially exposed, that family may be perfectly justified in spacing out their vaccination regimen. Problems arise when people want to have things both ways:

“They take newborns to Costco, a week old,” Dr. Miller said. “We want to do whatever we want to do, regardless of what our bodies are designed to do.”

Vaccinations are not just for children. Adults have the possibility of vaccinating against pneumonia, flu, shingles and other diseases.

Dr. Miller advocates mindful assessment of needs, risks and benefits. She says that she is an advocate of “purposeful” vaccination.

“Be in tune with what is going on in our community,” she said. “Protect yourself if you travel. I’ve seen some funny stuff coming back from Costa Rica.”

By the same token, one should not live in fear of lurking disease.

“Don’t go to the extreme of ‘if I don’t vaccinate against everything, I’m going to die!’” she said.

Dr. Miller throws up a caution flag of her own when it comes to pushes for vaccinations for diseases that can be avoided through lifestyle.

“How far should vaccines go?” she queries. “Should it be irresponsibility vaccines?”

Recent outbreaks of measles demonstrate that when rates of immunization drop, diseases that have been in check can rear their heads again virulently.

People in Sisters are fortunate in that they have access to more individualized and personal healthcare and can make appropriate choices in consultation with a doctor who actually knows them.

That personal relationship is key, as far as Dr. Miller is concerned. She defined her stance on vaccination baldly: “I’m pro vaccination that is very personal. That’s what I am.”