{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:05:40Z","timestamp":1786460740824,"version":"build-2736575974"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R37 AI054165"],"award-info":[{"award-number":["R37 AI054165"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Traditional measures of vaccine efficacy (VE) are inherently asymmetric, constrained above by 1 but unbounded below. As a result, VE estimates and corresponding confidence intervals (CIs) can extend far below zero, making interpretation difficult and potentially obscuring whether the apparent effect reflects true harm or simply statistical uncertainty. The proposed symmetric vaccine efficacy (SVE) is a bounded and interpretable alternative to VE that maintains desirable statistical properties while resolving these asymmetries. SVE is defined as a symmetric transformation of infection risks, with possible values within $[-1, 1]$, providing a common scale for both beneficial and harmful vaccine effects. This paper describes the relationship between SVE and traditional VE, considers inference about SVE, and illustrates the utility of the proposed measure by reanalyzing data from a randomized trial of a candidate HIV vaccine. Open-source tools for computing estimates of SVE and corresponding CIs are available in R through the sve package.<\/jats:p>","DOI":"10.1093\/biomtc\/ujag141","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:43:50Z","timestamp":1785843830000},"source":"Crossref","is-referenced-by-count":0,"title":["Symmetric vaccine efficacy"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7297-9359","authenticated-orcid":false,"given":"Lucy","family":"D\u2019Agostino\u00a0McGowan","sequence":"first","affiliation":[{"name":"Department of Statistical Sciences, Wake Forest University , Winston-Salem, NC 27106 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5380-2427","authenticated-orcid":false,"given":"Sarah C","family":"Lotspeich","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, Wake Forest University , Winston-Salem, NC 27106 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G","family":"Hudgens","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of North Carolina at Chapel Hill , Chapel Hill, NC 27599 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081108591078700_bib1","volume-title":"A new measure of treatment effect for random-effects meta-analysis of comparative binary outcome data","author":"Baker","year":"2018"},{"key":"2026081108591078700_bib2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1198\/000313006X90684","article-title":"Symmetrized percent change for treatment comparisons","volume":"60","author":"Berry","year":"2006","journal-title":"The American Statistician"},{"key":"2026081108591078700_bib3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijid.2023.03.022","article-title":"Observed negative vaccine effectiveness could be the canary in the coal mine for biases in observational COVID-19 studies","volume":"131","author":"Bodner","year":"2023","journal-title":"International Journal of Infectious Diseases"},{"key":"2026081108591078700_bib4","doi-asserted-by":"crossref","first-page":"100074","DOI":"10.1016\/j.dialog.2022.100074","article-title":"Relative risk reduction: Misinformative measure in clinical trials and COVID-19 vaccine efficacy","volume":"1","author":"Brown","year":"2022","journal-title":"Dialogues in Health"},{"key":"2026081108591078700_bib5","doi-asserted-by":"crossref","first-page":"e2232760","DOI":"10.1001\/jamanetworkopen.2022.32760","article-title":"Estimated effectiveness of COVID-19 vaccines against Omicron or Delta symptomatic infection and severe outcomes","volume":"5","author":"Buchan","year":"2022","journal-title":"JAMA Network Open"},{"key":"2026081108591078700_bib6","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1002\/(SICI)1097-0142(19960601)77:11<2193::AID-CNCR2>3.0.CO;2-R","article-title":"Understanding the relationship between relative and absolute risk","volume":"77","author":"Dupont","year":"1996","journal-title":"Cancer: Interdisciplinary International Journal of the American Cancer Society"},{"key":"2026081108591078700_bib7","first-page":"3","article-title":"On the \u201cprobable error\u201d of a coefficient of correlation deduced from a small sample","volume":"1","author":"Fisher","year":"1921","journal-title":"Metron"},{"key":"2026081108591078700_bib8","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/oxfordjournals.aje.a115884","article-title":"Direct and indirect effects in vaccine efficacy and effectiveness","volume":"133","author":"Halloran","year":"1991","journal-title":"American Journal of Epidemiology"},{"key":"2026081108591078700_bib9","doi-asserted-by":"publisher","DOI":"10.1101\/2021.12.20.21267966","article-title":"Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: A Danish cohort study","author":"Hansen","year":"2021","journal-title":"MedRxiv"},{"key":"2026081108591078700_bib10","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.2517-6161.1953.tb00135.x","article-title":"New light on the correlation coefficient and its transforms","volume":"15","author":"Hotelling","year":"1953","journal-title":"Journal of the Royal Statistical Society. Series B (Methodological)"},{"key":"2026081108591078700_bib11","volume-title":"Shall we count the living or the dead?","author":"Huitfeldt","year":"2021"},{"key":"2026081108591078700_bib12","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2307\/2531055","article-title":"On the bias of commonly used measures of association for 2 x 2 tables","volume":"42","author":"Jewell","year":"1986","journal-title":"Biometrics"},{"key":"2026081108591078700_bib13","doi-asserted-by":"crossref","first-page":"224","DOI":"10.7326\/0003-4819-107-2-224","article-title":"Meta-analysis in clinical research","volume":"107","author":"L\u2019Abb\u00e9","year":"1987","journal-title":"Annals of Internal Medicine"},{"key":"2026081108591078700_bib14","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1086\/428404","article-title":"Placebo-controlled phase 3 trial of a recombinant glycoprotein 120 vaccine to prevent HIV-1 infection","volume":"191","author":"rgp120 HIV Vaccine Study Group","year":"2005","journal-title":"The Journal of Infectious Diseases"},{"key":"2026081108591078700_bib15","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/j.1467-9868.2007.00598.x","article-title":"Estimation of treatment effects in randomized trials with non-compliance and a dichotomous outcome","volume":"69","author":"van\u00a0der\u00a0Laan","year":"2007","journal-title":"Journal of the Royal Statistical Society Series B: Statistical Methodology"},{"key":"2026081108591078700_bib16","volume-title":"Asymptotic Statistics","author":"van\u00a0der\u00a0Vaart","year":"1998"},{"key":"2026081108591078700_bib17","volume-title":"Design of vaccine efficacy trials to be used during public health emergencies\u2013points of considerations and key principles.","author":"World Health Organization","year":"2025"}],"container-title":["Biometrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/biometrics\/article-pdf\/82\/3\/ujag141\/70609296\/ujag141.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/biometrics\/article-pdf\/82\/3\/ujag141\/70609296\/ujag141.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T13:05:30Z","timestamp":1786453530000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/biometrics\/article\/doi\/10.1093\/biomtc\/ujag141\/8758871"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":17,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/biomtc\/ujag141","relation":{},"ISSN":["0006-341X","1541-0420"],"issn-type":[{"value":"0006-341X","type":"print"},{"value":"1541-0420","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,7,1]]},"article-number":"ujag141"}}