Hey,
> Are there certain scenarios where it works, for example does it work when Emacs is fully quit?
Good catch, it does actually open the Emacs for the first time but it cannot focus it.
> What full path do you have to Emacs, and which version of macOS are you using?
Standard `/Applications/Emacs.app`, Catalina 10.15.1, Alfred 4.0.6 (build 1124).