The basic follow functionality of Nostr is outbox-model-powered follow lists, that doesn't need to be solved.
But follow lists don't protect from reply spam, and they don't solve the need that some people have for seeing feeds of content from people they don't follow. Relay-based users and content curation and pubkey whitelisting do.
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Segregated relays also don't protect from spam (not more than general-purpose ones).
The issue you mention seems about the global feed. I think it's almost bound to be shit, but it can be addressed via hashtags.