Originally, Firefox required DoH to be enabled in order for ECH to function. Since Firefox 129, Firefox can fetch the necessary information via the OS DNS Resolver to enable ECH, allowing ECH to be used in more circumstances. Due a blocking bug with the MacOS DNS integration, MacOS still requires DoH to be enabled for ECH to be used, the work to fix this is tracked in 1882856.
For the vast majority of users, their native OS resolver will use unencrypted DNS to contact their local router which in turn passes their queries unencrypted on to their network provider. Fetching ECHConfigs via unencrypted DNS means that the sites the user visits are still leaked in plaintext to the network and so ECH delivers less value in this scenario. For this reason, we recommend the use of DoH (whether with a self-hosted or external DoH service) in order to benefit fully from the privacy protections of ECH.