Climbing the 'ladder of intrusiveness': the Italian government's strategy to push the Covid-19 vaccination coverage further

Abstract

In all Western countries, the vaccination campaign against COVID-19 encountered some resistance. To overcome vaccine inertia and hesitancy, governments have used a variety of strategies and policy instruments. These instruments can be placed on a 'ladder of intrusiveness', starting from voluntary tools based on simple information and persuasion, through material incentives and disincentives of varying nature and magnitude, to highly coercive tools, such as lockdown for the unvaccinated and the introduction of the vaccination mandate. Italy's experience during the vaccination campaign against Covid provides an ideal observational point for starting to investigate this issue: not only was Italy among the top countries with the highest percentage of people vaccinated at the beginning of 2022, but—at least compared to other European countries—it was also one of the countries that had gradually introduced the most intrusive measures to increase vaccination compliance. In the article the different steps of the ‘intrusiveness ladder’ are presented, providing examples from various countries, and then tested on the Italian Covid-19 vaccination campaign between 2021 and the first months of 2022. For each phase of the campaign, the instrument mixes adopted by the Italian government are described, as well as the contextual conditions that led to their adoption. In the final section, an assessment of the composition and evolution of the Italian vaccination strategy is provided, based on the following criteria: legitimacy, feasibility, effectiveness, internal consistency and strategic coherence. Conclusions highlight the pragmatic approach adopted by the Italian government and underline the effects—both positive and negative—of scaling up the intrusiveness ladder.

Health policy under the microscope: a micro policy design perspective

“…However, as the recent case of the COVID-19 vaccine has confirmed, in almost all countries, a not insignificant part of the population is reluctant to be vaccinated for a variety of reasons. To overcome this "vaccine inertia, " governments can use a variety of policy instruments that can be placed along a "ladder of intrusiveness" (31,(68)(69)(70) and that range from information tools (awareness campaigns, moral suasion) and material incentives and disincentives to personal restrictions (e.g., lockdowns for the unvaccinated). The imposition of vaccination mandates represents the top rung of this ladder of intrusiveness.…”