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Place a large skillet over medium heat. Add the olive oil, chopped shallot, and sauté for 1-2 minutes until softened.
Add the minced garlic and red pepper flakes, and sauté for 30-60 seconds until fragrant.
Stir in the tomato paste and cook for 1 minute. Pour in the vodka and cook for another 30-60 seconds to allow the alcohol to cook off.
Add the Ditalini and stir to coat in the sauce for 2-3 minutes.
Pour in the water or vegetable stock, season with salt and black pepper, and add the basil sprig (make sure it’s submerged). Cover with a lid and cook over medium heat, stirring often, until the pasta is al dente and most of the liquid has reduced, about 8-10 minutes.
Remove and discard the basil sprig. Lower the heat, stir in the heavy cream, and cook for another 2-3 minutes until the sauce is creamy and coats the pasta. For a thicker sauce, let it cook a bit longer (for a looser sauce, add a splash of water or stock).
Stir in ¼ cup of the grated Parmigiano Reggiano and mix well.
Serve the pasta in bowls. Top with mozzarella pearls, extra red pepper flakes (if using), more grated Parmigiano Reggiano, and a sprinkle of chopped parsley. Enjoy immediately.