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.

在所有西方国家，针对 COVID-19 的疫苗接种运动都遇到了一些阻力。为了克服疫苗的惰性和犹豫，各国政府采用了各种战略和政策工具。这些工具可以放在“侵入性的阶梯”上，从基于简单信息和说服的自愿工具，通过不同性质和程度的物质激励和抑制措施，到高度强制的工具，例如对未接种疫苗的人进行封锁和引入疫苗接种任务。意大利在新冠疫苗接种运动中的经验为开始调查这一问题提供了一个理想的观察点：意大利不仅是 2022 年初接种疫苗比例最高的国家之一，而且至少与其他欧洲国家相比——它也是逐步采取最具侵入性措施以提高疫苗接种依从性的国家之一。文章中介绍了“侵入性阶梯”的不同步骤，提供了来自不同国家的示例，然后在 2021 年至 2022 年前几个月的意大利 Covid-19 疫苗接种活动中进行了测试。对于活动的每个阶段，该工具描述了意大利政府采用的混合方案，以及导致其采用的背景条件。最后一部分根据以下标准对意大利疫苗接种战略的构成和演变进行了评估：合法性、可行性、有效性、内部一致性和战略一致性。结论强调了意大利政府采取的务实方法，并强调了扩大入侵阶梯的积极和消极影响。