President Lula dismissed Health Minister Nísia Trindade on Tuesday after prolonged internal friction and weeks of speculation about her removal from office. To replace Ms. Trindade, Mr. Lula appointed Alexandre Padilha, the current minister of institutional relations, who served as health minister during Dilma Rousseff's first term (2011–2014). He is set to take office on March 6.
Although long anticipated, Ms. Trindade's dismissal unfolded unusually. Mr. Lula met with her privately in his office, outside his official schedule. Just hours earlier, the two had participated in an event at the presidential palace where Ms. Trindade announced an agreement to produce Brazil's first domestically developed dengue vaccine.
Before an audience filled with dozens of civil servants, Ms. Trindade received a standing ovation as she took the stage alongside other high-ranking officials, including two ministers also rumored to be at risk of losing their posts: Márcio Macêdo (General Secretariat) and Luciana Santos (Science and Technology). Both have been frequently mentioned in speculation surrounding a cabinet reshuffle that President Lula is expected to carry out in the coming days or weeks to accommodate more members of the congressional main center-right bloc (known as “Centrão”) in his administration.
According to reports, Mr. Lula had not informed Ms. Trindade in advance about her impending dismissal. She became aware of the growing uncertainty around her position only through intermediaries or media reports. The same applied to Mr. Padilha—while he was confident he would take over the Health Ministry, he had not yet discussed the matter directly with the president. Their conversation took place in another off-schedule meeting in the afternoon, after Ms. Trindade had already been dismissed.
Following the official confirmation, Mr. Padilha took to social media to comment on his appointment.
“As an infectious disease physician, professor, and researcher in Brazil's public health system (SUS), as well as a former Health Minister, I understand the magnitude of this challenge. Brazil is the only country in the world with more than 100 million people covered by a universal, free public healthcare system,” he wrote. “Strengthening the SUS will continue to be our core mission, with a particular focus on reducing waiting times for those seeking medical care. This is the directive I have received from President Lula, and I will dedicate myself fully to it.”
Mr. Lula had noted issues with Ms. Trindade's performance for some time. Last year, she received criticism over the situation in federal hospitals in Rio de Janeiro and the increase in dengue cases nationwide. More recently, there were concerns regarding delays in launching the Mais Acesso a Especialistas program, which is intended to expand access to medical specialists.
Mr. Padilha's departure from the Institutional Relations Ministry (SRI) now leaves an open contest for the position, which plays a crucial role in political negotiations and handles the allocation of congressional budget earmarked funds.
The ministry is highly desired by the center-right bloc. Initially, one of the primary candidates considered for the position was the Minister of Ports and Airports, Silvio Costa Filho. According to a close associate, he was approached by Mr. Lula's representatives regarding the possibility of assuming Padilha's role. Nonetheless, both Mr. Costa Filho and his party preferred that he remain in his current position.
The frontrunners to replace Mr. Padilha are José Guimarães, the government's leader in the Lower House, and Gleisi Hoffmann, the national president of Lula's Workers' Party (PT). Mr. Lula has been reluctant to appoint a non-PT politician to the position unless it is someone he deeply trusts.
Mr. Lula has already decided that Ms. Hoffmann will join his cabinet, though her specific role remains undefined. She was previously considered for the General Secretariat if Mr. Macêdo were to be removed, but her name is now being floated for Mr. Padilha's former role. Besides her long-standing trust with Mr. Lula—strengthened by her leadership of the “Free Lula” campaign during his imprisonment—her appointment would also serve to offset the departure of another woman from a senior government position.
Meanwhile, factions within both the center-right bloc and the Workers' Party are advocating for Mr. Guimarães to take over the Institutional Relations Ministry. With strong ties to key congressional factions, including members of the right-wing Liberal Party (PL), Guimarães is considered the administration's main liaison with the “Centrão.” Neither Ms. Hoffmann nor Mr. Guimarães responded to requests for comment.
In Congress, reactions to Ms. Trindade's dismissal were swift. While government-aligned lawmakers expressed regret over her departure and praised her tenure, opposition lawmakers criticized her, arguing that she was removed due to incompetence.
Behind closed doors, center-right legislators mocked Mr. Padilha's transfer, noting that he had already faced mounting criticism as the government's political coordinator in Congress.
Sources familiar with the matter told Valor that there was growing dissatisfaction with Mr. Padilha's handling of the Institutional Relations Ministry, particularly regarding unmet agreements on budget-earmarked allocations. They argue that Mr. Lula, in his efforts to stabilize the political climate, is making a miscalculation by appointing him to a ministry with a large budget and significant control over parliamentary funds.
A more frustrated faction within the center-right bloc—concerned about not yet securing its expected share of influence—sees Mr. Padilha's “promotion” as yet another sign that Mr. Lula may be creating hurdles for his reelection bid in 2026.
Center-right leaders believe their dissatisfaction with Mr. Padilha's reassignment could be mitigated if Mr. Lula selects a minister with strong congressional ties to replace him. More importantly, they insist that the next appointee must advocate for lawmakers' interests and ensure that commitments between the Executive and Legislative branches are honored.
Their preference is for the role to go to someone from a center-right party, such as Isnaldo Bulhões or Silvio Costa Filho.